2020年天津市肺结核耐药流行病学特征及影响因素分析  

Epidemiological characteristics of drug-resistance and influencing factors in pulmonary tuberculosis patients in Tianjin,2020

作　　者：赵慧[1] 王志锐[1] 巨韩芳[1] 孙蕊[1] 王春花[1] Zhao Hui;Wang Zhirui;Ju Hanfang;Sun Rui;Wang Chunhua(Tianjin Center for Tuberculosis Control,Tianjin 300011,China)

机构地区：[1]天津市结核病控制中心,天津300011

出　　处：《疾病监测》2023年第1期57-63,共7页Disease Surveillance

基　　金：天津市卫生健康科技项目(No.ZC20199)。

摘　　要：目的分析2020年天津市肺结核患者的耐药流行病学特征及其影响因素。方法纳入2020年1—12月天津市的肺结核患者,对患者痰标本进行分离培养,分离鉴定结核分枝杆菌并进行药物敏感性试验。应用非条件logistic回归分析肺结核耐药患者的耐药流行病学特征及其影响因素。结果共纳入1314例肺结核患者,获得1314株结核分枝杆菌。其中,68.42%(899/1314)为全敏菌株,31.58%(415/1314)为耐药菌株。在415株耐药菌株中,10.05%(132/1314)为单耐药菌株,4.11%(54/1314)为多耐药菌株,10.81%(142/1314)为耐多药菌株,6.61%(87/1314)为其他类型耐药。结核分枝杆菌对异烟肼的耐药率最高(19.79%),其次为链霉素(18.87%),对利福平、左氧氟沙星、莫西沙星也有较高的耐药率(11.87%、13.13%、13.38%),对卡那霉素和阿米卡星的耐药率相对较低(0.91%、0.75%)。在156株利福平耐药结核分枝杆菌中,准广泛耐药率(同时对氟喹诺酮类耐药)为46.79%(73/156)。非条件logistic回归分析结果显示,与全敏组相比,单耐药组和多耐药/耐多药组中40~59岁者占比更高,≥60岁者占比更低(P<0.05)。与全敏组相比,单耐药组和多耐药/耐多药组中复治者占比均更高(P<0.05);与单耐药组相比,多耐药/耐多药组中复治者占比更高(P<0.05)。年龄、治疗史是结核分枝杆菌单耐药、多耐药/耐多药的影响因素(P<0.05)。复治耐药患者中的利福平耐药率、耐多药率、准广泛耐药率明显高于初治患者(P<0.001)。结论2020年天津市肺结核患者的耐药特征十分严峻,年龄40~59岁、治疗史等是肺结核患者耐药特别是利福平耐药的影响因素。Objective To investigate the epidemiological characteristics of drug-resistance in pulmonary tuberculosis(TB)patients and the influencing factors in Tianjin in 2020.Methods The pulmonary TB patients reported in Tianjin from January to December in 2020 were enrolled in this study and the sputum samples were collected from them for pathogen isolation and culture.The positive cultures were further identified to detect Mycobacterium tuberculosis.Drug susceptibility testing was used to detect the drug resistance of all the strains detected.The unconditional logistic regression analysis was performed to identify the influencing factors of drug-resistance in the pulmonary TB patients.Results A total of 1314 pulmonary TB patients were enrolled and 1314 M.tuberculosis strains were isolated.Among these strains,68.42%(899/1314)were pan-sensitive and 31.58%(415/1314)were drug-resistant.Of 415 drug-resistant strains,10.05%(132/1314)were mono resistant,4.11%(54/1314)were poly resistant,and 10.81%(142/1314)were multidrug resistant,and 6.61%(87/1314)had other patterns of drug resistance.The rate of isoniazid resistance was highest(19.79%),followed by the rate of streptomycin resistance(18.87%).The resistance rates to rifampin,levofloxacin and moxifloxacin were 11.87%,13.13%and 13.38%,respectively.The resistance rates to kanamycin and amikacin were relatively low(0.91%,0.75%).Among 156 rifampin resistant strains,the rate of preextensive drug-resistance(resistant to fluoroquinolone simultaneously)was 46.79%(73/156).The results of unconditional logistic regression analysis showed that,compared with the pan-sensitivity group,the proportion of the patients aged 40-59 years was higher in the mono resistance group and poly resistance/multidrug resistance group,while the proportion of the patients aged≥60 years was lower(P<0.05).Compared with the pan-sensitivity group,the proportion of the re-treated patients was higher in the mono resistance group and poly resistance/multidrug resistance group(P<0.05).Compared with the mono resistanc

关 键 词：肺结核 结核分枝杆菌 耐药性 药物敏感试验 影响因素 

分 类 号：R211[医药卫生—中医学] R521