2021-2023年内蒙古自治区兴安盟结核分枝杆菌耐药特征及耐多药影响因素分析  

Analysis of features of drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League of Inner Mongolia Autonomous Region, 2021—2023

作　　者：孙博 冯丽平 滕冲 朱含芳 赵冰[3] 冯涛 王庆奎 周浩 高星海 欧喜超[3] Sun Bo;Feng Liping;Teng Chong;Zhu Hanfang;Zhao Bing;Feng Tao;Wang Qingkui;Zhou Hao;Gao Xinghai;Ou Xichao(Department of Microbial Inspection,Hinggan League for Disease Control and Prevention,Inner Mongolia Autonomous Region,Ulanhot 137499,China;Department of Tuberculosis Control,Dongcheng District Center for Disease Control and Prevention,Beijing 100009,China;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,National Center for Tuberculosis Control and Prevention,Chinese Centre for Disease Control and Prevention,Beijing 102206,China;Clinical Laboratory,Hinggan League People’s Hospital,Department of Microbial Inspection,Inner Mongolia Autonomous Region,Ulanhot 137400,China;Hinggan League Third People’s Hospital,Inner Mongolia Autonomous Region,Ulanhot 137400,China;Clinical Laboratory,Arxan Center for Disease Control and Prevention Laboratory,Inner Mongolia Autonomous Region,Arxan 137899,China)

机构地区：[1]内蒙古自治区兴安盟疾病预防控制中心微生物检验科,乌兰浩特137499 [2]北京市东城区疾病预防控制中心结核病防治科,北京100009 [3]传染病溯源预警与智能决策全国重点实验室,中国疾病预防控制中心结核病预防控制中心,北京102206 [4]内蒙古自治区兴安盟人民医院检验科,乌兰浩特137400 [5]内蒙古自治区兴安盟第三人民医院,乌兰浩特137400 [6]内蒙古自治区兴安盟阿尔山市疾病预防控制中心检验科,阿尔山137899

出　　处：《结核与肺部疾病杂志》2024年第5期437-444,共8页Journal of Tuberculosis and Lung Disease

基　　金：内蒙古自治区科技创新引导项目(2022003)。

摘　　要：目的:分析2021—2023年内蒙古自治区兴安盟结核分枝杆菌耐药特征及耐多药影响因素,为当地预防控制耐药结核病的发生与流行提供科学依据。方法:通过“中国疾病预防控制信息系统”的子系统“疾病监测信息报告管理系统”收集2021年1月1日至2023年12月30日兴安盟下辖的全部6个旗(县、市)615例培养阳性肺结核患者的登记信息,采用微孔板法对分离的615株结核分枝杆菌进行16种抗结核药物敏感性(简称“药敏”)试验,进行统计描述,同时采用logistic回归模型分析肺结核患者耐多药的影响因素。结果:(1)药敏试验结果显示,16种抗结核药物任意耐药率较高的为异烟肼(INH;13.01%,80/615)、链霉素(Sm;11.71%,72/615)、卡那霉素(Km;6.99%,43/615)、环丝氨酸(Cs;6.18%,38/615)及利福平(RFP;5.37%,33/615)。在初治患者与复治患者中,RFP、Km、利福布汀(Rfb)、对氨基水杨酸(PAS)及对氨基水杨酸异烟肼(PAS-INH)的任意耐药率[4.22%(20/474)和9.22%(13/141)、5.49%(26/474)和12.06%(17/141)、1.05%(5/474)和4.26%(6/141)、1.69%(8/474)和5.67%(8/141)、1.05%(5/474)和4.26%(6/141)]差异均有统计学意义(χ^(2)=5.351,P=0.021;χ^(2)=7.217,P=0.007;χ^(2)=4.646,P=0.031;χ^(2)=5.332,P=0.021;χ^(2)=4.646,P=0.031)。(2)在615株结核分枝杆菌菌株中,有198株耐药株,总耐药率为32.20%(198/615),RFP耐药率为2.28%(14/615),单耐药率为20.33%(125/615),多耐药率为8.78%(54/615),耐多药率为3.09%(19/615)。耐药谱共有46种组合,单耐药9种,多耐药24种,耐多药(不包含原准广泛耐药)9种,原准广泛耐药4种,其中复治患者中多耐药的耐药率(15.60%,22/141)高于初治患者(6.75%,32/474)(χ^(2)=10.631,P=0.001)。(3)复治患者与重点人群发生耐多药的风险更高(OR=3.232,95%CI:1.187~8.805;OR=3.388,95%CI:1.211~9.479);直接就诊对发生耐多药有保护作用(OR=0.196,95%CI:0.043~0.885)。结论:2021—2023年兴安盟地区耐药谱呈现复杂性和多样性,治疗史、是否重点Objective:To analyze the drug resistance of Mycobacterium tuberculosis and risk factors of multidrug-resistance in Hinggan League,Inner Mongolia from 2021 to 2023,and provide scientific evidence for preventing the occurrence and prevalence of drug-resistant tuberculosis in Hinggan League.Methods:The registration information of 615 culture positive patients in six counties(banners)of Hinggan League from January 1st,2021 to December 30th,2023 were collected from China National Notifiable Infectious Disease Reporting Information System,and the drug susceptibility tests of 615 strains of Mycobacterium tuberculosis to 16 anti-tuberculosis drugs were carried out using the microplate method and the influencing factors of multi-drug resistance of tuberculosis patients were analyzed using the logistic regression model.Results:(1)The drug susceptibility test results showed that the higher resistance rates to 16 anti-tuberculosis drugs were INH(13.01%,80/615),Sm(11.71%,72/615),Km(6.99%,43/615),Cs(6.18%,38/615),and RFP(5.37%,33/615).There were statistically significant differences in the resistance rates of RFP,Km,Rfb,PAS,and PAS-INH(4.22%(20/474)and 9.22%(13/141),5.49%(26/474)and 12.06%(17/141),1.05%(5/474)and 4.26%(6/141),1.69%(8/474)and 5.67%(8/141),1.05%(5/474)and 4.26%(6/141))between initial and retreatment patients(χ^(2)=5.351,P=0.021;χ^(2)=7.217,P=0.007;χ^(2)=4.646,P=0.031;χ^(2)=5.332,P=0.021;χ^(2)=4.646,P=0.031).(2)There were 198 drug-resistant strains among 615 strains,with a overall drug resistance rate of 32.20%(198/615),RFP resistance rate of 2.28%(14/615),Mono-drug resistance rate of 20.33%(125/615),poly-resistance rate of 8.78%(54/615),multidrug-resistance rate of 3.09%(19/615).The drug resistance spectrum of the sixteen anti-tuberculosis drugs consisted of 46 different types of drug resistance,including 9 types of mono-drug resistance,24 types of poly-resistance,9 types of multidrug-resistance(not including pre-extensive drug resistance),and 4 types of extensive drug resistance.The poly-resistance rate(15

关 键 词：分枝杆菌 结核 结核 抗多种药物性 因素分析 统计学 兴安盟 

分 类 号：R211[医药卫生—中医学] R521