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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (7): 685-689.doi: 10.19982/j.issn.1000-6621.20220028

• 论著 • 上一篇    下一篇

2016—2020年广东省结核病耐药监测结果分析

陈燕梅, 温文沛(), 吴惠忠, 徐镠粤, 彭柯皓, 余美玲   

  1. 广东省结核病控制中心,广州 510630
  • 收稿日期:2022-02-09 出版日期:2022-07-10 发布日期:2022-07-06
  • 通信作者: 温文沛 E-mail:568323856@qq.com
  • 基金资助:
    “十三五”国家科技重大专项(2018ZX10715004-003-004);广东省医学科研基金项目(A2020072)

Analysis of monitoring results of tuberculosis drug-resistance in Guangdong Province from 2016 to 2020

CHEN Yan-mei, WEN Wen-pei(), WU Hui-zhong, XU Liu-yue, PENG Ke-hao, YU Mei-ling   

  1. Centre for Tuberculosis Control of Guangdong Province, Guangzhou 510630, China
  • Received:2022-02-09 Online:2022-07-10 Published:2022-07-06
  • Contact: WEN Wen-pei E-mail:568323856@qq.com
  • Supported by:
    Major National Science and Technology Projects during the 13th five-year Plan(2018ZX10715004-003-004);Medical Science and Technology Research Foundation of Guangdong(A2020072)

摘要: 目的 了解2016—2020年广东省结核病患者耐药情况及趋势,为全省耐药结核病的防控提供科学依据。方法 收集2016年1月1日至2020年12月31日广东省32个耐药监测点所有活动性肺结核患者作为研究对象,共纳入92851例。收集研究对象临床信息,对研究对象的痰标本进行涂片和分离培养,培阳菌株进行菌群鉴定,共获得结核分枝杆菌(MTB)分离株30362株。采用比例法对MTB分离株开展9种抗结核药品[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)]的药物敏感性试验(简称“药敏试验”),并分析菌株的耐药情况。 结果 30362株菌株的总耐药率为26.75%(8121/30362),耐多药率为3.34%(1014/30362),单耐药率为15.88%(4820/30362),多耐药率为7.53%(2286/30362)。菌株对9种抗结核药品的任一耐药率由高至低依次为Sm(14.59%,4430/30362)>INH(9.25%,2810/30362)>RFP(6.22%,1887/30362)>EMB(5.72%,1737/30362)>Ofx(3.03%,920/30362)>Pto(3.00%,912/30362)
>PAS(2.25%,684/30362)>Cm(2.00%,606/30362)>Km(1.63%,494/30362),差异有统计学意义(χ2=8889.800,P<0.01)。菌株中27783株分离自初治患者,2579株分离自复治患者,复治患者的耐药率[35.32%(911/2579)]和耐多药率[10.35%(267/2579)]均明显高于初治患者[耐药率为25.95%(7210/27783),耐多药率为2.69%(747/27783)],差异均有统计学意义(χ2=105.800,P<0.01;χ2=265.700,P<0.01)。5年间初治患者的耐多药率呈上升趋势[2016年为2.76%(152/5502),2020年为3.19%(166/5203)],复治患者的耐药率呈下降趋势[2016年为38.85%(169/435),2020年为35.02%(173/494)],差异均有统计学意义(χ趋势2值分别为6.584和6.334,P值分别为0.010和0.012)。珠三角地区来源菌株的耐药率和耐多药率[分别为27.35%(4540/16597)和3.59%(596/16597)]均高于粤东西北地区来源菌株[耐药率为26.02%(3581/13765);耐多药率为3.04%(418/13765)],差异均有统计学意义(χ2值分别为6.886和3.879,P值分别为0.009和0.049)。结论 广东省耐药结核病流行形势依然严峻,利福平耐药、初治患者耐药及流动人口结核病耐药等问题需重点关注。

关键词: 结核, 抗药性, 细菌, 人群监测

Abstract: Objective: To understand the situation and trend of drug resistance of tuberculosis patients in Guangdong Province from 2016 to 2020, so as to provide scientific basis for the prevention and control of drug-resistant tuberculosis. Methods: A total of 92851 patients with active pulmonary tuberculosis from 32 drug resistance surveillance sites in Guangdong Province from January 1, 2016 to December 31, 2020 were collected. The clinical information of the subjects was collected, the sputum samples were smeared, isolated and cultured, and the positive strains in culture were identified. A total of 30362 isolates of Mycobacterium tuberculosis (MTB) were obtained. The drug sensitivity test of 9 anti-tuberculosis drugs (isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), ofloxacin (Ofx), capreomycin (Cm), propylthionicotinamide (Pto) and sodium aminosalicylate (PAS) was carried out on MTB isolates by proportional method, and the drug resistance of the strains was analyzed. Results: The total drug resistance rate of 30362 strains was 26.75% (8121/30362), the multidrug resistance rate was 3.34% (1014/30362), the single drug resistance rate was 15.88% (4820/30362), and the multidrug resistance rate was 7.53% (2286/30362). The resistance rate of the strain to any one of the nine anti-tuberculosis drugs from high to low was Sm (14.59%, 4430/30362)>INH (9.25%, 2810/30362)>RFP (6.22%, 1887/30362)>EMB (5.72%, 1737/30362)>Ofx (3.03%, 920/30362)>Pto (3.00%, 912/30362)>PAS (2.25%, 684/30362)>Cm (2.00%, 606/30362)>Km (1.63%, 494/30362), the difference was statistically significant (χ2=8889.800, P<0.01). Of the strains, 27783 were isolated from primary patients and 2579 strains were isolated from retreated patients. The drug resistance rate and multidrug resistance rate of retreated patients were significantly higher than those of primary patients (35.32% (911/2579) vs. 25.95% (7210/27783), χ 2=105.800, P<0.01; 10.35% (267/2579) vs. 2.69% (747/27783), χ 2=265.700, P<0.01). During the five years, the multidrug resistance rate of newly treated patients showed an upward trend (2.76% (152/5502) in 2016 and 3.19% (166/5203) in 2020), and the drug resistance rate of retreated patients showed a downward trend (38.85% (169/435) in 2016 and 35.02% (173/494) in 2020), the difference was statistically significant (χtrend2=6.584 and 6.334, P=0.010 and 0.012, respectively). The drug resistance rate and multidrug resistance rate of the strains from the Pearl River Delta region were significantly higher than those from the eastern and northwestern regions of Guangdong Province (27.35% (4540/16597) vs. 26.02% (3581/13765), χ 2=6.886, P=0.009; 3.59% (596/16597) vs. 3.04% (418/13765), χ 2=3.879, P=0.049). Conclusion: The epidemic situation of drug-resistant tuberculosis in Guangdong Province is still serious. Rifampicin resistance, drug resistance of newly treated patients and drug resistance of tuberculosis in floating population should be paid special attention.

Key words: Tuberculosis, Drug resistance, bacterial, Population surveillance

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