海南省耐多药结核病的近期传播相关影响因素  

Factors influencing the recent transmission of multidrug-resistant tuberculosis in Hainan Province

作　　者：钟业腾 王洁莹 陈灼霖 许玉妮 邱文华 裴华[1] ZHONG Yeteng;WANG Jieying;CHEN Zhuolin;XU Yuni;QIU Wenhua;PEI Hua(Department of Clinical Laboratory,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570216,China)

机构地区：[1]海南医学院第二附属医院检验科,海南海口570216

出　　处：《中国热带医学》2024年第4期443-449,494,共8页China Tropical Medicine

基　　金：海南省重点研发项目(No.ZDYF2022SHFZ100);海南省自然科学基金项目(No.820MS144,No.822RC844);海南省卫生健康行业科研项目(No.22A200271,No.22A200272)。

摘　　要：目的探讨耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)的近期传播相关影响因素,以期为海南省MDR-TB防控及临床提供流行病学依据。方法收集2019年7月—2021年6月在海南医学院第二附属医院就诊的MDR-TB患者临床呼吸道标本进行分枝杆菌分离培养,经比例法药敏筛选出耐多药结核分枝杆菌(multidrug-resistant Mycobacterium tuberculosis,MDR-MTB)菌株进行全基因组测序(whole-genome sequencing,WGS),结合临床流行学资料,分析MDR-TB的近期传播影响因素。结果共有202例MDR-TB患者纳入研究,主要分布在海南省的18个市县(除三沙市),患者以男性为主。MDR-MTB菌株的谱系分析显示,有56.4%(114/202)为Lineage2.2(Beijing)、27.2%(55/202)为Lineage2.1(non-Beijing)、13.4%(27/202)为Lineage4(Euro-American)、3.0%(6/202)为Lineage1(Indo-Oceanic)。通过遗传距离分析,发现了15个簇的42株MDR-MTB菌株,MDR-MTB菌株成簇率为20.8%,存在一定程度的近期传播。近期传播相关因素分析显示,非农民职业、初治、未婚患者与MDR-TB的近期传播有正相关性,而高龄和吸烟史患者则与其负相关。Lineage2.2(Beijing)相较于Lineage2.1(non-Beijing)更易发生MDR-TB传播。多因素Logistic回归模型分析进一步证实初治患者可能为MDR-TB的近期传播的独立危险因素。结论海南省MDR-TB具有独特遗传多样性,但Lineage2.2仍为主要流行株,海南省MDR-TB的近期传播与非农民职业、初治、未婚、Lineage2.2(Beijing)有关,初治患者可能是传播的独立危险因素,为MDR-TB的控制提供了重要线索,有望指导相关防控策略的制定,以减少MDRTB疫情传播。Objective To investigate the influencing factors related to the recent transmission of multidrug-resistant tuberculosis(MDR-TB)in Hainan Province,with the goal of providing an epidemiological basis for the region's prevention and control strategies,as well as clinical decision-making regarding MDR-TB.Methods Clinical respiratory specimens from MDR-TB patients treated at the Second Affiliated Hospital of Hainan Medical University from July 2019 to June 2021 were collected for mycobacterial isolation and cultivation.Isolates of multidrug-resistant Mycobacterium tuberculosis(MDR-MTB)identified through proportional drug-susceptibility screening were subjected to whole-genome sequencing(WGS).In conjunction with clinical and epidemiological data,factors influencing recent MDR-TB transmission were analyzed.Results A total of 202 MDR-TB patients were included in the study,primarily distributed across 18 cities and counties of Hainan Province(excluding Sansha City),and the patients were predominantly male.Phylogenetic analysis of the MDR-MTB strains showed that 56.4%(114/202)belonged to Lineage 2.2(Beijing),27.2%(55/202)to Lineage 2.1(non-Beijing),13.4%(27/202)to Lineage 4(Euro-American),and 3.0%(6/202)to Lineage 1(Indo-Oceanic).Through genetic distance analysis,42 strains of MDR-MTB were found to be grouped into 15 clusters,with a clustering rate of 20.8%,indicating a significant level of recent transmission.Analysis of transmission-related factors revealed that non-agricultural occupations,initial treatment,and unmarried status were positively correlated with recent MDR-TB transmission,while older age and a history of smoking were negatively correlated.Notably,Lineage 2.2(Beijing)showed a higher likelihood of MDR-TB transmission compared to Lineage 2.1(non-Beijing).Multivariate logistic regression analysis further identified that patients receiving initial treatment were an independent risk factor for recent MDR-TB transmission.Conclusions MDR-TB in Hainan Province exhibits distinctive genetic diversity,with Lineage 2.2

关 键 词：耐多药结核病 结核分枝杆菌 危险因素 近期传播 全基因组测序 

分 类 号：R521[医药卫生—内科学]