长沙市2018—2021年耐多药和准广泛耐药肺结核的流行特征分析  

Epidemiological characteristics of multi-drug resistant tuberculosis and pre-extensively drug resistant tuberculosis in Changsha,2018-2021

作　　者：徐明忠[1] 王孝君[1] 熊姿[1] 宋丽新[1] 田斌[1] XU Ming-zhong;WANG Xiao-jun;XIONG Zi;SONG Li-xin;TIAN Bin(Changsha Center for Disease Control and Prevention,Changsha,Hu'nan 410001,China)

机构地区：[1]长沙市疾病预防控制中心,湖南长沙410001

出　　处：《中国热带医学》2023年第5期479-483,共5页China Tropical Medicine

基　　金：湖南省自然科学基金项目(No.2022JJ70049)。

摘　　要：目的 了解长沙市结核耐药监测状况,探索长沙市耐多药结核病(multi-drug resistant tuberculosis,MDR-TB)和准广泛耐药结核病(pre-extensively drugresistant tuberculosis,pre-XDR-TB)的流行特点,为全市耐药结核病防治提供科学依据。方法 收集长沙市2018—2021年病原学阳性肺结核患者耐药监测数据,分析病原学阳性肺结核患者耐药筛查成功率,MDR-TB和pre-XDR-TB的发生率和变化趋势。结果 2018—2021年,MDR-TB成功筛查率分别为86.2%、87.7%、81.9%和71.5%,pre-XDR-TB成功筛查率分别是82.5%、84.8%、76.9%和68.2%。MDR-TB患者数占各年度成功筛查人数的7.6%(101/1 222)、6.5%(124/1 774)、6.6%(110/1 555)和6.3%(99/1 478),pre-XDR-TB患者数占各年成功筛查人数的3.6%(46/1 219)、3.8%(69/1 766)、4.4%(69/1 495)和4.6%(69/1 436)。MDX-TB发生率呈缓慢下降趋势,pre-XDR-TB发生率呈缓慢上升趋势,下降和上升趋势均无统计学意义(χ^(2)=1.947,0.806,P>0.05)。MDR-TB在复治失败人群中发生率是66.6%(2/3),在其他、初治失败和复发人群中的发生率依次是23.5%(19/81)、16.7%(2/12)和15.2%(70/461)。pre-XDR-TB在初治失败人群中的发生率是16.7%(2/12),在其他、复发和返回患者中的发生率依次是12.2%(9/74)、9.8%(43/439)和4.5%(2/44)。MDR-TB和pre-XDR-TB在不同人群中的发生率差异有统计学意义(χ^(2)=117.600,59.030,P<0.05)。结论 长沙市结核耐药监测体系仍需加以改善,在持续关注复治失败、其他、初治失败和复发患者的耐药性检测工作的前提下,需探讨应用高灵敏度的分子药敏检测技术和探索制定科学高效的筛查策略。Objective To understand the situation of drug-resistant tuberculosis screening and epidemiological characteristics of multi-drug resistant tuberculosis(MDR-TB)and pre-extensively drug resistant tuberculosis(pre-XDR-TB)in Changsha,in order to provide a scientific basis for improving the quality of drug-resistant tuberculosis prevention and control in the city.Methods Demographic information and drug susceptibility date of etiologically positive pulmonary tuberculosis patients in Changsha from 2018 to 2021 were collected,the successful rate of resistance screening,incidence and tendency in MDR-TB and pre-XDR-TB in patients included in this study were statistically analyzed accordingly.Results From 2018 to 2021,the successful screening rates were 86.2%,87.7%,81.9%and 71.5%for MDR-TB and 82.2%,84.8%,76.9%and 68.2%for pre-XDR-TB,respectively.In each year,MDR-TB patients identified accounted for 7.6%(101/1222),6.5%(124/1774),6.6%(110/1555)and 6.3%(99/1478),and pre-XDR-TB patients identified accounted for 3.6%(46/1219),3.8%(69/1766),4.4%(69/1495)and 4.6%(69/1436),correspondingly.The incidence of MDR-TB showed a slowly downward trend,while the incidence of pre-MDR-TB showed a slowly upward trend,with neither decreasing nor increasing trends being statistically significant((χ^(2)=1.947,0.806,P>0.050).The incidence of MDR-TB in the retreatment failure population was 66.6%(2/3),and the others,failure initial treatment and recrudescence populations were 23.5%(19/81),16.7%(2/12)and 15.2%(70/461),respectively.Similar to the incidence above,the incidence of pre-XDR-TB was 16.7%(2/12)among patients who failed in initial treatment,and 12.2%(9/74),9.8%(43/439),and 4.5%(2/44)among the others,recrudescence and returned patients,respectively.The incidence rates of MDR-TB and pre-XDR-TB in different populations were significantly different(χ^(2)=117.600,59.030,P<0.05).Conclusions There are still areas for improvement in tuberculosis drug resistance surveillance system in Changsha.On the premise of paying attention to patients in ret

关 键 词：结核 结核分枝杆菌 耐药性 检测 趋势 长沙市 

分 类 号：R521.1[医药卫生—内科学]