河北省2020年结核病耐药监测结果分析

doi:10.19982/j.issn.1000-6621.20210638

摘要/Abstract

摘要：

目的: 了解河北省结核病耐药疫情及趋势,为制定适合河北省的耐药结核病防治策略提供依据。方法: 采用简单随机抽样的方法抽取河北省14个监测县(区)作为耐药监测点,对2020年监测点的424例培养阳性肺结核患者采用比例法药物敏感性试验(简称“药敏试验”)对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(Sm)、卡那霉素(Km)、氧氟沙星(Ofx)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸钠(PAS)进行耐药性检测。结果: (1)总耐药:初治患者耐INH率最高[9.19%(35/381)],复治患者耐RFP率最高[13.95%(6/43)],总体耐INH率最高[9.43%(40/424)]。(2)单耐药:初治、复治、总体均是单耐RFP率最高[依次为1.84%(7/381)、6.98%(3/43)、2.36%(10/424)]。(3)多耐药:初治患者耐INH+Sm率最高[0.79%(3/381)],复治患者耐INH+Sm、INH+EMB+Sm率最高[均为2.33%(1/43)],总体耐INH+Sm最高[0.94%(4/424)]。(4)耐多药:初治患者耐INH+RFP、 INH+RFP+Km+Ofx率最高[1.31%(5/381)],复治患者耐INH+RFP+EMB率最高[4.65%(2/43)],总体耐INH+RFP、INH+RFP+Km+Ofx率最高[1.18%(5/424)]。总体耐药率为34.20%(145/424),其中初治患者耐药率为33.07%(126/381),复治患者耐药率为44.19%(19/43); 总体耐多药率为5.42%(23/424),其中初治患者耐多药率为5.25%(20/381),复治患者耐多药率为6.98%(3/43)。结论: 河北省2020年结核病耐药形势严峻,要注意一线、二线药物尤其是Km、Ofx的规范使用,从而降低耐药率。

关键词: 结核, 抗药性, 流行病学研究

Abstract:

Objective: To understand the epidemic situation and trend of multi-drug resistant tuberculosis (MDR-TB) in Hebei Province,providing scientific evidence for formulating suitable strategies for MDR-TB prevention and control for the province. Methods: A total of 14 surveillance counties (districts) in Hebei province were selected as drug resistance surveillance sites by simple random sampling.A total of 424 culture positive TB patients were selected from those surveillance sites in 2020. Isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), ofloxacin (Ofx), capreomycin (Cm), prothioisinamide (Pto),and sodium P-aminosalicylate (PAS) were tested for drug resistance with the proportional drug susceptibility test. Results: (1) Overall drug resistance: rate of resistance to INH was the highest in newly treated patients (9.19% (35/381)), rate of resistance to RFP was the highest in re-treated patients (13.95% (6/43)). Overall INH resistance rate was (9.43% (40/424)).(2) Monoresistance: the rate of monoresistance to RFP was the highest in newly treated patients, re-treated patients and all patients (1.84% (7/381), 6.98% (3/43), 2.36% (10/424), respectively). (3) Polydrug resistance: the INH+Sm resistance rate was the highest in newly treated patients (0.79% (3/381)), INH+Sm and INH+EMB+Sm resistance rate were the highest in retreated patients (both were 2.33% (1/43)), and INH+Sm resistance rate was the highest among all patients (0.94% (4/424)). (4) Multidrug resistance:INH+RFP and INH+RFP+Km+Ofx resistance rate were the highest in newly treated patients (both were 1.31% (5/381)), and INH+RFP+EMB resistance rate was the highest in retreated patients (4.65% (2/43)). The INH+RFP and INH+RFP+Km+Ofx resistance rates were the highest (both were 1.18% (5/424)) among all patients.The overall drug resistance rate was 34.20% (145/424), 33.07% (126/381) in newly treated patients and 44.19% (19/43) in retreated patients.The overall rate of multidrug resistance was 5.42% (23/424), 5.25% (20/381) in newly treated patients and 6.98% (3/43) in retreated patients. Conclusion: The situation of tuberculosis resistance in Hebei is serious in 2020.We should pay more attention on standardized use of first-line and second-line drugs, especially for Km and Ofx, to reduce drug resistance rate.

Key words: Tuberculosis, Drug resistance, Epidemiologic studies

中图分类号:

R521
R97

解冰洁, 靳飞, 张俊丽, 徐华, 陈海峰, 张会民. 河北省2020年结核病耐药监测结果分析[J]. 中国防痨杂志, 2022, 44(4): 403-408. doi: 10.19982/j.issn.1000-6621.20210638

XIE Bing-jie, JIN Fei, ZHANG Jun-li, XU Hua, CHEN Hai-feng, ZHANG Hui-min. Analysis of drug resistance among tuberculosis patients in Hebei Province in 2020[J]. Chinese Journal of Antituberculosis, 2022, 44(4): 403-408. doi: 10.19982/j.issn.1000-6621.20210638

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耐药类型	初治患者(381例)		复治患者(43例)		合计(424例)		χ²值	P值
耐药类型	例数	耐药率(%)	例数	耐药率(%)	例数	耐药率(%)	χ²值	P值
总耐药
INH	35	9.19	5	11.63	40	9.43	-^a	0.582
RFP	30	7.87	6	13.95	36	8.49	1.838	0.241
EMB	8	2.10	3	6.98	11	2.59	-^a	0.090
Sm	16	4.20	2	4.65	18	4.25	-^a	0.703
Ofx	8	2.10	0	0.00	8	1.89	-^a	1.000
Km	5	1.31	0	0.00	5	1.18	-^a	1.000
Cm	10	2.62	2	4.65	12	2.83	-^a	0.348
Pto	8	2.10	1	2.33	9	2.12	-^a	1.000
PAS	6	1.57	0	0.00	6	1.42	-^a	1.000
单耐药
INH	6	1.57	0	0.00	6	1.42	-^a	1.000
RFP	7	1.84	3	6.98	10	2.36	-^a	0.070
EMB	0	0.00	0	0.00	0	0.00
Sm	6	1.57	0	0.00	6	1.42	-^a	1.000
Ofx	2	0.52	0	0.00	2	0.47	-^a	1.000
Km	0	0.00	0	0.00	0	0.00
Cm	4	1.05	1	2.33	5	1.18	-^a	0.416
Pto	1	0.26	0	0.00	1	0.24	-^a	1.000
PAS	1	0.26	0	0.00	1	0.24	-^a	1.000
多耐药
INH+EMB	2	0.52	0	0.00	2	0.47	-^a	1.000
INH+Sm	3	0.79	1	2.33	4	0.94	-^a	0.355
INH+Sm+PAS	1	0.26	0	0.00	1	0.24	-^a	1.000
RFP+Cm+PAS	1	0.26	0	0.00	1	0.24	-^a	1.000
RFP+Cm+Pto	1	0.26	0	0.00	1	0.24	-^a	1.000
INH+Sm+Pto	1	0.26	0	0.00	1	0.24	-^a	1.000
INH+EMB+Sm	1	0.26	1	2.33	2	0.47	3.503	0.193
RFP+Ofx+Pto	1	0.26	0	0.00	1	0.24	-^a	1.000
INH+Sm+Cm+PAS	1	0.26	0	0.00	1	0.24	-^a	1.000
耐多药
INH+RFP	5	1.31	0	0.00	5	1.18	-^a	1.000
INH+RFP+EMB	2	0.52	2	4.65	4	0.94	-^a	0.053
INH+RFP+Cm+Pto	3	0.79	1	2.33	4	0.94	-^a	0.349
INH+RFP+EMB+Sm	3	0.79	0	0.00	3	0.71	-^a	1.000
INH+RFP+Km+Ofx	5	1.31	0	0.00	5	1.18	-^a	1.000
INH+RFP+Pto+PAS	2	0.52	0	0.00	2	0.47	-^a	1.000

不同特征	初治患者(381例)			复治患者(43例)			合计(424例)			χ²值	P值
不同特征	例数	总耐药数	总耐药率(%)	例数	总耐药数	总耐药率(%)	例数	总耐药数	总耐药率(%)	χ²值	P值
性别										0.453	0.289
男	270	85	31.48	34	16	47.06	304	101	33.22
女	111	41	36.94	9	3	33.33	120	44	36.67
年龄(岁)										5.044	0.169
0~19	17	3	17.65	1	0	0.00	18	3	16.67
20~39	125	46	36.80	13	9	69.23	138	55	39.86
40~59	101	33	32.67	10	5	50.00	111	38	34.23
60~93	138	44	31.88	19	5	26.32	157	49	31.21
地区										0.014	0.906
城镇	86	28	32.56	12	6	50.00	98	34	34.69
农村	295	98	33.22	31	13	41.94	326	111	34.05
合计	381	126	33.07	43	19	44.19	424	145	34.20	2.121	0.145

不同特征	初治患者(381例)			复治患者(43例)			合计(424例)			χ²值	P值
不同特征	例数	单耐药数	单耐药率(%)	例数	单耐药数	单耐药率(%)	例数	单耐药数	单耐药率(%)	χ²值	P值
性别										1.319	0.251
男	270	22	8.15	34	3	8.82	304	25	8.22
女	111	5	4.50	9	1	11.11	120	6	5.00
年龄(岁)										-^a	0.167
0~19	17	1	5.88	1	0	0.00	18	1	5.56
20~39	125	6	4.80	13	1	7.69	138	7	5.07
40~59	101	7	6.93	10	3	30.00	111	10	9.01
60~93	138	13	9.42	19	0	0.00	157	13	8.28
地区										0.659	0.417
城镇	86	7	8.14	12	2	16.67	98	9	9.18
农村	295	20	6.78	31	2	6.45	326	22	6.75
合计	381	27	7.09	43	4	9.30	424	31	7.31	0.280	0.597

不同特征	初治患者(381例)			复治患者(43例)			合计(424例)			χ²值	P值
不同特征	例数	多耐药数	多耐药率(%)	例数	多耐药数	多耐药率(%)	例数	多耐药数	多耐药率(%)	χ²值	P值
性别										0.337	0.562
男	270	10	3.70	34	1	2.94	304	11	3.62
女	111	2	1.80	9	1	11.11	120	3	2.50
年龄(岁)										3.536	0.060
0~19	17	0	0.00	1	0	0.00	18	0	0.00
20~39	125	8	6.40	13	0	0.00	138	8	5.80
40~59	101	4	3.96	10	1	10.00	111	5	4.50
60~93	138	0	0.00	19	1	5.26	157	1	0.64
地区										1.294	0.255
城镇	86	5	5.81	12	0	0.00	98	5	5.10
农村	295	7	2.37	31	2	6.45	326	9	2.76
合计	381	12	3.15	43	2	4.65	424	14	3.30	-^a	0.643

不同特征	初治患者(381例)			复治患者(43例)			合计(424例)			χ²值	P值
不同特征	例数	耐多药数	耐多药率(%)	例数	耐多药数	耐多药率(%)	例数	耐多药数	耐多药率(%)	χ²值	P值
性别										3.421	0.064
男	270	15	5.56	34	2	5.88	304	17	5.59
女	111	5	4.50	9	1	11.11	120	6	5.00
年龄(岁)										-^a	0.806
0~19	17	1	5.88	1	0	0.00	18	1	5.56
20~39	125	7	5.60	13	1	7.69	138	8	5.80
40~59	101	3	2.97	10	1	10.00	111	4	3.64
60~93	138	9	6.52	19	1	5.26	157	10	6.37
地区										0.734	0.392
城镇	86	6	6.98	12	1	8.33	98	7	7.14
农村	295	14	4.75	31	2	6.45	326	16	4.91
合计	381	20	5.25	43	3	6.98	424	23	5.42	-^a	0.718