吉林市结核分枝杆菌耐药情况及趋势预测分析  

Analysis and trend prediction of Mycobacterium tuberculosis drug resistance in Jilin City

作　　者：刘菊秀 张建华 温均筠 姜晓双 Liu Juxiu;Zhang Jianhua;Wen Junjun;Jiang Xiaoshuang(Department of Tuberculosis Medicine,Jilin City Tuberculosis Hospital,Jiaohe 132506,China)

机构地区：[1]吉林市结核病医院结核内科,蛟河132506

出　　处：《中国防痨杂志》2025年第3期348-354,共7页Chinese Journal of Antituberculosis

摘　　要：目的:分析近年吉林市肺结核患者耐药情况及变化趋势。方法:采用回顾性研究方法,参照入组标准收集2023年1月至2024年6月吉林市结核病医院收治的796例菌阳肺结核患者基本信息和痰标本结核分枝杆菌药物敏感性试验(简称“药敏试验”)结果,分析吉林市肺结核患者耐药情况,并对不同类型耐药情况进行时间序列趋势预测分析。结果:2023年1月至2024年6月,796例患者对16种抗结核药物的总耐药率为43.59%(347/796),其中,耐多药率、单耐药率、多耐药率、准广泛耐药率分别为14.82%(118/796)、9.30%(74/796)、2.01%(16/796)、5.90%(47/796),未发现广泛耐药患者。对16种抗结核药物的任一药物耐药率高于10%的顺位依次为:链霉素(26.26%,209/796)>异烟肼(23.87%,190/796)>利福平(18.84%,150/796)>利福布汀(14.70%,117/796)>左氧氟沙星(13.57%,108/796)>莫西沙星(12.31%,98/796)>帕司烟肼(11.43%,91/796)。老年组单耐药率[13.20%(45/341)]高于中年组[5.86%(17/290)]和青年组[7.27%(12/165)],青年组和中年组耐多药率[20.00%(33/165)和18.97%(55/290)]均高于老年组[8.80%(30/341)],青年组和中年组准广泛耐药率[7.88%(13/165)和10.00%(29/290)]均高于老年组[2.05%(7/341)],差异均有统计学意义(χ2=11.009,P=0.004;χ2=17.248,P<0.001;χ2=18.204,P<0.001)。复治患者的耐多药率[28.02%(72/257)]和准广泛耐药率[14.79%(38/257)]均高于初治患者[分别为8.53%(46/539)和2.03%(11/539)],差异均有统计学意义(χ2=52.307,P<0.001;χ2=48.934,P<0.001)。对趋势预测的时间序列分析结果显示:2024年7—12月吉林市单耐药率、多耐药率、耐多药率和准广泛耐药率分别为6.67%、0.78%、11.92%和4.02%。结论:吉林市2023年1月至2024年6月肺结核患者各种类型耐药率均处于较高水平,预测2024年7—12月不同耐药类型的耐药率均呈下降趋势,但耐多药和准广泛耐药仍处于较高水平,故应加强对耐药肺结核患者防控管理,实时监测链霉素、异�Objective:To analyze the drug resistance status and change trend among pulmonary tuberculosis(PTB)patients in Jilin City in recent years.Methods:A retrospective study was conducted,basic information and drug susceptibility test(DST)result of Mycobacterium tuberculosis from samples of 796 sputum-positive PTB patients admitted to Jilin City Tuberculosis Hospital between January 2023 and June 2024 were collected according to inclusion criteria.Their drug resistance status was analyzed,and time-series trend prediction was performed for different types of drug resistance.Results:From January 2023 to June 2024,the overall drug resistance rate to 16 anti-tuberculosis drugs among 796 patients was 43.59%(347/796).The rates of multidrug resistance(MDR),mono-drug resistance,poly-drug resistance,and pre-extensive drug resistance(pre-XDR)were 14.82%(118/796),9.30%(74/796),2.01%(16/796),and 5.90%(47/796),respectively.No extensively drug-resistant(XDR)cases were detected.The drugs with a resistance rate exceeding 10%were ranked as follows:streptomycin(26.26%,209/796)>isoniazid(23.87%,190/796)>rifampicin(18.84%,150/796)>rifabutin(14.70%,117/796)>levofloxacin(13.57%,108/796)>moxifloxacin(12.31%,98/796)>pasiniazide(11.43%,91/796).The mono-drug resistance rate in the elderly group(13.20%,45/341)was higher than that in the middle-aged group(5.86%,17/290)and the young group(7.27%,12/165).The MDR rates in the young group(20.00%,33/165)and middle-aged group(18.97%,55/290)were higher than that in the elderly group(8.80%,30/341).Pre-XDR rates in the young group(7.88%,13/165)and middle-aged group(10.00%,29/290)were also higher than that in the elderly group(2.05%,7/341).All differences were statistically significant(χ2=11.009,P=0.004;χ2=17.248,P<0.001;χ2=18.204,P<0.001).MDR(28.02%,72/257)and pre-XDR rates(14.79%,38/257)were higher in retreatment patients than in new patients(8.53%(46/539)and 2.03%(11/539),respectively),with statistically significant differences(χ2=52.307,P<0.001;χ2=48.934,P<0.001).Time-series analysis predicted that

关 键 词：结核 抗多种药物性 药物监测 模型 统计学 预测 传染病控制 

分 类 号：R52[医药卫生—内科学]