2019—2020年广西柳州市基于全患者人群的耐药肺结核筛查策略分析  

Strategy-analysis of drug-resistant tuberculosis screening based on all suspected tuberculosis patients of Liuzhou City,Guangxi,2019-2020

作　　者：梁月新 刘爱梅 曾慧频 黄丽花 吕柳英 曾新艳 李丽媛 黄俊理 Liang Yuexin;Liu Aimei;Zeng Huipin;Huang Lihua;Lyu Liuying;Zeng Xinyan;Li Liyuan;Huang Junli(Accreditation Office of Tertiary Hospital,Guangxi Chest Hospital,Liuzhou 545005,China;Administrative Office,Guangxi Chest Hospital,Liuzhou 545005,China;Public Health Section,Guangxi Chest Hospital,Liuzhou 545005,China;Clinical Lab,Guangxi Chest Hospital,Liuzhou 545005,China;Internal Medicine,Guangxi Chest Hospital,Liuzhou 545005,China;The Fourth Ward of Tuberculosis Department,Guangxi Chest Hospital,Liuzhou 545005,China)

机构地区：[1]广西壮族自治区胸科医院三甲办,柳州545005 [2]广西壮族自治区胸科医院院办,柳州545005 [3]广西壮族自治区胸科医院公共卫生科,柳州545005 [4]广西壮族自治区胸科医院医学检验科,柳州545005 [5]广西壮族自治区胸科医院内科,柳州545005 [6]广西壮族自治区胸科医院结核科四病区,柳州545005

出　　处：《中国防痨杂志》2024年第8期958-966,共9页Chinese Journal of Antituberculosis

基　　金：广西壮族自治区科技厅重大专项项目(桂科AA22096027);广西医疗卫生适宜技术开发与推广应用项目(S2022041,S2019035)。

摘　　要：目的:了解广西柳州市基于全患者人群的耐药肺结核筛查情况,为进一步优化筛查策略提供科学依据。方法:采用前瞻性研究方法,通过中国疾病预防控制中心“传染病监测系统结核病专报系统”选择2019年1月1日至2020年12月31日广西柳州市5个城区(城中区、鱼峰区、柳南区、柳北区、柳江区)和5个所辖县区(柳城县、鹿寨县、融水苗族自治县、融安县、三江侗族自治县)的6050例疑似肺结核患者,采用分子生物学技术和表型药物敏感性试验对2943株鉴定为结核分枝杆菌复合群(MTBC)的菌株(包括来自新发患者的2514株,高危人群患者的429株)进行耐药性筛查,并对耐药肺结核流行病学特征和两种检测技术的临床效能进行分析。结果:6050例疑似肺结核患者的病原学阳性检出率为52.23%(3160/6050),全患者人群病原学阳性患者耐药筛查率为93.13%(2943/3160),2943株MTBC共检出耐药菌株132株,耐药检出率为4.49%(132/2943),其中,利福平耐药肺结核占2.04%(60/2943),耐多药肺结核占2.38%(70/2943),广泛耐药肺结核占0.07%(2/2943);高危人群耐药检出率[12.59%(54/429)]明显高于新发患者[3.10%(78/2514)],差异有统计学意义(χ^(2)=76.954,P<0.001);来自高危人群的复发患者的耐药检出率[32.65%(32/98)]明显高于复治失败患者[2.63%(2/76)],差异有统计学意义(χ^(2)=44.106,P<0.001)。耐药肺结核患者流行病学特征显示,65岁以上老年人、离退休、高危人群患者、有吸烟史、有饮酒史和有糖尿病史的患者耐药检出率[分别为5.92%(58/979)、8.22%(12/146)、12.59%(54/429)、43.81%(46/105)、38.13%(53/139)、66.67%(12/18)]均高于18~64岁青壮年、农民、新发患者、无吸烟史、无饮酒史和无糖尿病史的患者[分别为3.98%(72/1810)、4.10%(91/2221)、3.10%(78/2514)、3.03%(86/2838)、2.82%(79/2804)、4.10%(120/2925)],差异均有统计学意义(χ^(2)值分别为9.471、10.061、76.954、393.038、385.474、163.457,P值�Objective:To understand the situation of drug-resistant tuberculosis(DR-TB)screening in all suspected TB patients in Liuzhou,Guangxi,and to provide a scientific basis for further optimization of screening strategies.Methods:A prospective study was conducted by selecting 6050 suspected tuberculosis patients from 5 urban districts(Chengzhong,Yufeng,Liunan,Liubei,Liujiang)and 5 counties(Liucheng,Luzhai,Rongshui,Rong’an,Sanjiang)in Liuzhou,from January 1st,2019 to December 31st,2020,in the Tuberculosis Report of Infectious Disease Surveillance System of the National Center for Disease Control and Prevention,using molecular biology techniques and phenotypic antimicrobial susceptibility test to screen for drug resistance in 2943 strains identified as Mycobacterium tuberculosis complex(MTBC),including 2514 strains in new patients and 429 strains in patients from drug-resistant high-risk groups,and the epidemiological characteristics of DR-TB and the clinical effectiveness of the two detection techniques were analyzed.Results:Of the 6050 suspected tuberculosis patients,the etiologically positive rate was 52.23%(3160/6050),the drug resistance screening rate of the etiologically positive patients was 93.13%(2943/3160),and a total of 132 strains of DR-TB were detected from 2943 strains of MTBC,with a drug-resistance detection rate of 4.49%(132/2943),among which,rifampicin-resistant tuberculosis(RR-TB)was 2.04%(60/2943),multidrug-resistant tuberculosis(MDR-TB)was 2.38%(70/2943),and extensively drug-resistant tuberculosis(XDR-TB)was 0.07%(2/2943);drug-resistant detection rate in high-risk groups(12.59%(54/429))was significantly higher than that of new patients(3.10%(78/2514),χ^(2)=76.954,P<0.001).Among high-risk groups,drug resistance detection rate was highest in relapsed patients(32.65%(32/98)),significantly higher than that in relapsed treatment failure patients(2.63%(2/76),χ^(2)=44.106,P<0.001).Epidemiological characteristics of DR-TB patients showed that drug-resistance rates of patients aged 65 years or older,retire

关 键 词：结核 肺 结核 抗多种药物性 卫生服务研究 人群监测 

分 类 号：R521[医药卫生—内科学] R195[医药卫生—临床医学]