2009-2020年江苏省南通市耐多药/利福平耐药肺结核诊疗服务特征的纵向研究  

A longitudinal study on the characteristics of diagnosis and treatment service of multidrug-resistant/rifampicin resistant pulmonary tuberculosis from 2009 to 2020 in Nantong City,Jiangsu Province

作　　者：车贝贝 王小平[3] 邱青 陈诚[5] 郑旭彬 赵琦[2,7] 徐飚 Che Beibei;Wang Xiaoping;Qiu Qing;Chen Cheng;Zheng Xubin;Zhao Qi;Xu Biao(Department of Epidemiology,School of Public Health,Fudan University,Shanghai 200032,China;Key Lab of Health Technology Assessment,National Health Commission,Fudan University,Shanghai 200032,China;Department of Chronic Communicable Disease,Center for Disease Control and Prevention in Nantong City,Jiangsu Province,Nantong 226006,China;The Third Tuberculosis Ward,the Sixth People’s Hospital of Nantong,Jiangsu Province,Nantong 226001,China;Department of Chronic Communicable Disease,Center for Disease Control and Prevention of Jiangsu Province,Nanjing 210009,China;Clinic and Research Center of Tuberculosis,Shanghai Key Laboratory of Tuberculosis,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China;Department of Social Medicine,School of Public Health,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,上海200032 [2]复旦大学国家卫生健康委员会卫生技术评估重点实验室,上海200032 [3]南通市疾病预防控制中心慢性传染性防制科,南通226006 [4]南通市第六人民医院结核三病区,南通226001 [5]江苏省疾病预防控制中心慢性传染病防制所,南京210009 [6]同济大学附属上海市肺科医院结核病临床研究中心,上海200433 [7]复旦大学公共卫生学院社会医学教研室,上海200032

出　　处：《中国防痨杂志》2023年第9期864-871,共8页Chinese Journal of Antituberculosis

基　　金：国家自然科学基金(82173581)。

摘　　要：目的:纵向描述江苏省南通市2009-2020年耐多药/利福平耐药肺结核(MDR/RR-PTB)患者发现、人群特征和诊疗情况,为优化MDR/RR-PTB卫生政策提供科学依据。方法:基于“结核病信息管理系统”,导出南通市2009-2020年MDR/RR-PTB管理数据库,描述MDR/RR-PTB检出率、患者特征、诊断延误和治疗情况的纵向变化趋势。结果:南通市2009-2020年共确诊MDR/RR-PTB患者426例,其中2014-2020年共筛查4030例,检出率为5.43%(219/4030)。MDR/RR-PTB的检出率因筛查政策调整年间略有波动,从2014年的16.83%(34/202)下降至2020年的2.85%(32/1123),总体呈缓慢下降趋势(Z趋势=-11.541,P<0.001)。12年间登记的MDR/RR-PTB患者中,初治的比例从2009年的0上升至2020年的53.12%(17/32),≥80岁的患者的比例从2009年的53.85%(7/13)下降至2020年的3.12%(1/32)。患者的诊断延误总体呈现下降趋势,由2009年的97(78,207) d下降至2020年的0(0,0) d。纳入治疗的MDR/RR-PTB患者的治疗成功率从2009年的60.00%(6/10)升高至2020年的71.88%(23/32),病亡率由2009年的20.00%(2/10)下降至2020年的9.38%(3/32)。结论:南通市MDR/RR-PTB患者检出率稳中有降,维持在相对较低水平,登记患者随时间呈年轻化趋势,初治患者占比逐年升高,患者的诊断延误时间显著下降。建议规范患者尤其是利福平耐药肺结核患者的治疗管理,减少耐药肺结核的传播。Objective:To describe the longitudinal changes of case finding,clinical features and treatment for multidrug-resistant/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB)in Nantong City,Jiangsu Province from 2009 to 2020,and to provide scientific guidance for optimizing the prevention and treatment policies for MDR/RR-PTB.Methods:Based on the Tuberculosis Information Management System,we collected the associated data of MDR/RR-PTB patients registered from 2009—2020 in Nantong City,Jiangsu Province.Longitudinal changes of detection rate,demographic characteristics,diagnostic delay,treatment coverage and treatment outcome for MDR/RR-PTB patients were depicted.Results:A total of 426 MDR/RR-PTB patients were detected in Nantong from 2009 to 2020.From 2014 to 2020,4030 patients were screened,with an overall detection rate of 5.43%(219/4030).The detection rate fluctuated slightly over the years in response to different screening policy,from 16.83%(34/202)in 2014 to 2.85%(32/1123)in 2020,with a significantly decline trend(Ztrend=-11.541,P<0.001).During the past 12 years,the proportion of newly treated MDR/RR-PTB patients increased from 0 in 2009 to 53.12%(17/32)in 2020,and the proportion of patients aged≥80 years decreased from 53.85%(7/13)in 2009 to 3.12%(1/32)in 2020.Overall,the diagnostic delay showed a decreasing trend since 2009,with the number of 97(78,207)days in 2009 and 0(0,0)day in 2020.As for treatment outcome among those received standardized treatment,the treatment success rate increased from 60.00%(6/10)in 2009 to 71.88%(23/32)in 2020,and the case fatality rate decreased from 20.00%(2/10)in 2009 to 9.38%(3/32)in 2020.Conclusion:This study showed that the detection rate of MDR/RR-PTB steadily decreased and maintained at a low level,while MDR/RR-PTB patients tended to be younger over time in Nantong City,and the proportion of newly treated patients increased annually.Diagnostic delay of MDR/RR-PTB patients tended to decrease.It is recommended to strengthen the standardized management of treatment in

关 键 词：结核 抗药性 院内诊疗 流行病学研究特征(主题) 纵向研究 

分 类 号：R521[医药卫生—内科学]