2015—2022年天水市肺结核患者耐药情况及利福平耐药特征分析  

Analysis of drug resistance situation results and rifampicin resistance characteristics in pulmonary tuberculosis patients in Tianshui City from 2015 to 2022

作　　者：李江红[1] 雷彩英 颜淑萍[1] 刘晓岚[1] 杨琪 王热勤[2] 刘芳[3] 杨枢敏[3] Li Jianghong;Lei Caiying;Yan Shuping;Liu Xiaolan;Yang Qi;Wang Reqin;Liu Fang;Yang Shumin(Department of Tuberculosis Prevention and Control,Tianshui Center for Disease Control and Prevention,Gansu Province,Tianshui 741000,China;Department of Disinfection and Sterilization,Tianshui Center for Disease Control and Prevention,Gansu Province,Tianshui 741000,China;Department of Tuberculosis Control and Prevention,Gansu Provincial Center for Disease Control and Prevention,Lanzhou 730000,China)

机构地区：[1]甘肃省天水市疾病预防控制中心结防科,天水741000 [2]甘肃省天水市疾病预防控制中心消杀科,天水741000 [3]甘肃省疾病预防控制中心结防所,兰州730000

出　　处：《中国防痨杂志》2024年第3期340-348,共9页Chinese Journal of Antituberculosis

基　　金：甘肃省自然科学基金(21JrR7RA656)。

摘　　要：目的:分析2015—2022年甘肃省天水市肺结核患者耐药情况及利福平耐药特征,为优化耐药结核病卫生政策提供科学依据。方法:采用回顾性研究方法,从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中收集2015—2022年天水市肺结核患者实验室检测结果、耐药筛查和耐药结核病诊断信息等资料,分析患者病原学阳性率、药物敏感性试验结果和耐药诊断时间等。结果:2015—2022年,天水市共登记活动性肺结核患者8458例,除外结核性胸膜炎的肺结核患者为7895例,病原学阳性率为28.32%(2236/7895),且从2015年的11.33%(177/1562)上升至2022年的61.30%(236/385),呈明显上升趋势(χ_(趋势)^(2)=1014.480,P=0.000);天水市应耐药筛查肺结核患者2360例,实际耐药筛查率为85.00%(2006/2360),从2015年的54.80%(97/177)上升至2022年的93.39%(240/257),呈明显上升趋势(χ_(趋势)^(2)=397.292,P=0.000);天水市耐药检出率为98.90%(1984/2006),利福平耐药检出率为15.73%(312/1984),从2015年的10.42%(10/96)上升至2017年的28.57%(62/217),再下降至2022年的11.34%(27/238),呈先上升后下降趋势(χ_(趋势)^(2)=27.248,P=0.000)。312例利福平耐药患者中,男性[198例(63.46%)]多于女性[114例(36.54%)];年龄相对集中在20~29岁[85例(27.24%)]和40~49岁[66例(21.15%)],且老年患者(60~83岁)比例从2016年的9.52%(2/21)上升至2022年的25.93%(7/27),呈明显上升趋势(χ_(趋势)^(2)=4.801,P=0.028);职业以农民为主[213例(68.27%)];痰涂片结果以涂阳患者居多[215例(68.91%)],但痰涂片阳性率从2015年的100.00%(10/10)下降至2022年的59.26%(16/27),呈下降趋势(χ_(趋势)^(2)=17.664,P=0.000)。耐药谱前3位依次为利福平+异烟肼+乙胺丁醇[26.92%(84/312)]、利福平[26.28%(82/312)]和利福平+异烟肼[23.40%(73/312)]。耐药患者诊断时间中位数(四分位数)从2016年的145(91,196)d逐年下降至2019年的21(12,39)d。结论:2015—2022年天水市肺结核患者病原学Objective:Analyze the drug resistance situation and basic characteristics of rifampicin resistance in pulmonary tuberculosis(PTB)patients from 2015 to 2022 in Tianshui City,Gansu Province,to provide scientific basis for optimizing the health policy of drug-resistant tuberculosis.Methods:Adopting a retrospective analysis method,we collected information of tuberculosis registration,laboratory testing,drug resistance screening and drug resistant tuberculosis diagnosis in Tianshui City from 2015 to 2022 from“China Disease Prevention and Control Information System”subsystem“Tuberculosis Management Information System”,analyzed etiologically positive rate among patients,drug susceptibility test results and resistance diagnosis time,etc.Results:From 2015 to 2022,a total of 8458 registered PTB patients were detected in Tianshui City,excluding tuberculous pleurisy,there were 7895 cases of PTB,with an etiologically positive rate of 28.32%(2236/7895),rising from 11.33%(177/1562)in 2015 to 61.30%(236/385)in 2022,showing an upward trend(χ_(trend)^(2)=1014.480,P=0.000).Among 2360 patients with PTB who should be screened for drug resistance in Tianshui City,the drug resistance screening rate was 85.00%(2006/2360),which increased from 54.80%(97/177)in 2015 to 93.39%(240/257)in 2022,showing an upward trend(χ_(trend)^(2)=397.292,P=0.000),and the detection rate of drug resistance in Tianshui City was 98.90%(1984/2006),and the rifampicin resistance rate was 15.73%(312/1984),which increased from 10.42%(10/96)in 2015 to 28.57%(62/217)in 2017 and then decreased to 11.34%(27/238)in 2022,showing a trend of firstly increasing and then decreasing(χ_(trend)^(2)=27.248,P=0.000).Among the 312 patients with rifampicin resistance,there were more males(198 cases,63.46%)than females(114 cases,36.54%),relatively concentrated among 20-29 years old(85 cases,27.24%)and 40-49 years old(66 cases,21.15%)patients,mainly farmers(213 cases,68.27%),and sputum smear results were mostly positive(215 cases,68.91%).The proportion of elderly patients(6

关 键 词：结核 肺 结核 抗多种药物性 卫生服务研究 人群监测 天水市 

分 类 号：R521[医药卫生—内科学] R195[医药卫生—临床医学]