2011—2020年长沙市MTB/HIV双重感染流行特征分析

doi:10.19982/j.issn.1000-6621.20220040

摘要/Abstract

摘要：

目的: 分析长沙市MTB/HIV双重感染流行特征,以完善相关防控策略。方法: 从《结核病管理信息系统》和《TB/HIV双重感染防治管理工作年度报表》中提取2011—2020年长沙市MTB/HIV双感者相关资料,建立长沙市MTB/HIV感染特征分布综合数据库。分析MTB/HIV双重感染的检出情况,描述其随年度变化的趋势以及在不同时间、性别、年龄和地区的流行分布特征。结果: 2011—2020年,长沙市累计发现MTB/HIV双重感染者280例,患者发现率随年度呈波动性上升[4.29%(12/280)~15.36%(43/280)]。其中,在结核病患者中检出HIV感染者39例,年均检出率为0.10%(39/38990),不同年度HIV阳性检出率[0.03%(1/3759)~0.22%(9/4057)]呈波动性上升趋势(Z=2.347,P=0.019);在HIV/AIDS患者中检出MTB感染者241例,年均检出率为0.68%(241/35381),不同年度肺结核检出率[0.41%(19/4639)~2.13%(13/610)]呈波动性下降趋势(Z=-6.126,P=0.001)。在280例MTB/HIV双重感染者中,性别分布以男性为主[85.71%(240/280)];年龄分布以25~44岁年龄组为主[46.78%(131/280)],其次是45~64岁年龄组[32.50%(91/280)];地区分布以浏阳市为最多[26.07%(73/280)],其次为长沙县和宁乡市[均为16.43%(46/280)]。结论: 长沙市MTB/HIV双重感染水平较低,但在结核病患者中筛查HIV感染者的年均检出率呈波动上升趋势,在HIV/AIDS者中筛查MTB感染者的检出率呈波动下降趋势。应以男性、25~44岁年龄组以及AIDS及结核病疫情分布较高地区的人群为防控重点。

关键词: 分枝杆菌,结核, HIV感染, 共病现象, 流行病学研究特征(主题)

Abstract:

Objective: To analyze the epidemic characteristics of MTB/HIV double infection in Changsha, and to improve the prevention and control strategies. Methods: The data of MTB/HIV dual infection patients in Changsha from 2011 to 2020 were extracted from Tuberculosis Information Management System and TB/HIV Dual Infection Prevention and Management Annual Report, to establish a comprehensive database of MTB/HIV characteristics and distribution in Changsha. The detection of MTB/HIV dual infection, description of the annual change trend and the epidemic distribution characteristics in different time, gender, age and region were analyzed. Results: From 2011 to 2020, a total of 280 MTB/HIV double infection cases were found in Changsha, the patient detection rate fluctuated with the year (4.29% (12/280)-15.36% (43/280)). Among them, HIV infection were detected in 39 tuberculosis patients, with an annual detection rate of 0.10% (39/38990). The HIV positive rate showed an increasing trend of fluctuation in different years (0.03% (1/3759)-0.22% (9/4057))(Z=2.347, P=0.019). Among HIV/AIDS patients, MTB infection were detected in 241 cases, and the average annual detection rate was 0.68% (241/35381). The detection rate of tuberculosis showed a decreasing trend with fluctuation in different years (0.41% (19/4639)-2.13% (13/610))(Z=-6.126,P=0.001). The 280 MTB/HIV dual infected patients were mainly male (85.71% (240/280)); and the age was mainly at 25-44 years (46.78% (131/280)), followed by 45-64 years old (32.50% (91/280)). As to regional distribution, Liuyang City had the most cases (26.07% (73/280)), followed by Changsha County and Ningxiang City (both 16.43% (46/280)). Conclusion: The level of MTB/HIV double infection in Changsha was low, but the average annual detection rate of HIV infection among tuberculosis patients showed a fluctuating upward trend. The detection rate of MTB infection in HIV/AIDS screening showed a fluctuating downward trend. The prevention and control should be focused on male and 25-44 years age group, as well as people in areas with high prevalence of AIDS and tuberculosis.

Key words: Mycobacterium,tuberculosis, HIV Infections, Comorbidity, Epidemiologic study characteristics as topic

中图分类号:

熊姿, 谢赐福, 宋丽新, 王孝君, 田斌, 黄竹林, 徐祖辉, 张锡兴, 白丽琼. 2011—2020年长沙市MTB/HIV双重感染流行特征分析[J]. 中国防痨杂志, 2022, 44(5): 484-488. doi: 10.19982/j.issn.1000-6621.20220040

XIONG Zi, XIE Ci-fu, SONG Li-xin, WANG Xiao-jun, TIAN Bin, HUANG Zhu-lin, XU Zu-hui, ZHANG Xi-xing, BAI Li-qiong. Epidemiological characteristics of MTB/HIV double infection in Changsha from 2011 to 2020[J]. Chinese Journal of Antituberculosis, 2022, 44(5): 484-488. doi: 10.19982/j.issn.1000-6621.20220040

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参考文献 24

[1]	Greenall M, Kunii O, Thomson K, et al. Reaching vulnerable populations:lessons from the Global Fund to Fight AIDS,Tuberculosos and Malaria. Bull World Health Organ, 2017, 95(2):159-161. doi: 10.2471/blt.16.179192. doi: 10.2471/blt.16.179192 URL
[2]	成诗明, 周林, 刘二勇, 等. 结核分枝杆菌和艾滋病病毒双重感染防治合作模式与效果. 中国防痨杂志, 2011, 33(7): 416-421.
[3]	World Health Organization. WHO Policy on Collaborative TB/HIV Activities:Guidelines for National Programmes and Other Stakeholders. Geneva: World Health Organization, 2012.
[4]	包昌林, 杨华林, 白丽琼, 等. 湖南省9县区TB/HIV双向筛查及抗结核病治理转过结果分析. 实用预防医学, 2010, 17(10): 1972-1975. doi: 10.3969/j.issn.1006-3110.2010.10.017. doi: 10.3969/j.issn.1006-3110.2010.10.017
[5]	中华人民共和国卫生部. WS 293-2008艾滋病和艾滋病病毒感染诊断标准. 2008-02-28.
[6]	中华人民共和国国家卫生健康委员会. WS 293-2019艾滋病和艾滋病病毒感染诊断标准. 2019-01-02.
[7]	中华人民共和国卫生部. WS 288-2008肺结核诊断标准. 2008-01-16.
[8]	中华人民共和国国家卫生和计划生育委员会. WS 288-2017肺结核诊断. 2017-11-09.
[9]	卫生部疾病预防控制局, 卫生部医政司, 中国疾病预防控制中心. 中国结核病防治规划实施工作指南(2008年版). 北京: 中国协和医科大学出版社, 2009:72-73.
[10]	中华人民共和国国家卫生健康委员会. 中国结核病预防控制工作技术规范(2020年版). 2020-04-02.
[11]	World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization, 2021.
[12]	王前, 李涛, 杜昕, 等. 2015-2019年全国肺结核报告发病情况分析. 中国防痨杂志, 2021, 43(2):107-112. doi: 10.3969/j.issn.1000-6621.2021.02.002. doi: 10.3969/j.issn.1000-6621.2021.02.002
[13]	中国疾病预防控制中心结核病预防控制中心. 2019年中国结核病监测报告. 北京: 中国疾病预防控制中心结核病预防控制中心, 2020.
[14]	曹红, 邓晓岚, 钱冰, 等. 2014-2019年合肥市MTB/HIV双重感染防治情况分析. 中国防痨杂志, 2021, 43(8): 803-807. doi: 10.3969/j.issn.1000-6621.2021.08.009. doi: 10.3969/j.issn.1000-6621.2021.08.009
[15]	齐威, 庞学文, 李敬新. 天津市2011-2015年结核菌与艾滋病病毒双重感染筛查结果分析. 华南预防医学, 2017, 43(3): 253-255. doi: 10.13217/j.scjpm.2017.0253. doi: 10.13217/j.scjpm.2017.0253
[16]	杜雨华, 江坤洪, 陈其琛, 等. 广州地区Mtb/HIV双重感染筛查情况及临床疗效. 热带医学杂志, 2017, 17(12): 1680-1683. doi: 10.3969/j.issn.1672-3619.2017.12.030. doi: 10.3969/j.issn.1672-3619.2017.12.030
[17]	魏静, 贺良, 赵娜, 等. 2013-2017年重庆市万州区新发肺结核病例HIV抗体检测结果分析. 寄生虫病与感染性疾病, 2018, 16(2): 76-77.
[18]	黄家运, 李小媛, 黎舒, 等. 2013-2017年南宁市登记肺结核患者HIV感染情况. 职业与健康, 2019, 35(8): 1063-1066. doi: 10.13329/j.cnki.zyyjk.2019.0281. doi: 10.13329/j.cnki.zyyjk.2019.0281
[19]	刘惠, 闻颖. 艾滋病患者和HIV感染者中结核潜伏性感染的诊断与预防性治疗. 中国防痨杂志, 2016, 38(1):57-60. doi: 10.3969/j.issn.1000-6621.2016.01.013. doi: 10.3969/j.issn.1000-6621.2016.01.013
[20]	王前, 何金戈, 李玉红, 等. 人工智能自动阅片技术用于HIV/AIDS人群结核病主动筛查效果的研究. 中国防痨杂志, 2021, 43(6):557-561. doi: 10.3969/j.issn.1000-6621.2021.06.007. doi: 10.3969/j.issn.1000-6621.2021.06.007
[21]	孟思润, 吴锋耀, 陈萧羽, 等. 广西艾滋病合并结核病双重感染情况及其影响因素分析. 中国临床新医学, 2017, 10(4): 299-302.doi: 10.3969/j.issn.1674-3806.2017.04.01. doi: 10.3969/j.issn.1674-3806.2017.04.01
[22]	徐祖辉, 张传芳, 肖军, 等. 湖南省HIV/AIDS人群中结核病患病及其影响因素研究. 中国医师杂志, 2016, 18(2):187-190. doi: 10.3760/cma.j.issn.1008-1372.2016.02.008. doi: 10.3760/cma.j.issn.1008-1372.2016.02.008
[23]	韦辉, 李博, 蓝光华. 中国老年人群艾滋病流行特征研究进展. 应用预防医学, 2021, 27(2):189-193. doi: 10.3969/j.issn.1673-758X.2021.02.032. doi: 10.3969/j.issn.1673-758X.2021.02.032
[24]	宋丽新, 王孝君, 熊姿, 等. 长沙市2009-2018年肺结核疫情流行性特征分析. 中国卫生标准管理, 2020, 11(5):3-6. doi: 10.3969/j.issn.1674-9316.2020.05.002. doi: 10.3969/j.issn.1674-9316.2020.05.002

年份	结核病患者			HIV/AIDS者
年份	登记例数	HIV抗体检测例数 (检测率,%)	HIV抗体阳性例数 (检出率,%)	随访例数	结核病筛查例数 (筛查率,%)	诊断结核病例数 (检出率,%)
2011	5162	2086(40.41)	1(0.05)	926	610(65.87)	13(2.13)
2012	5042	2900(57.52)	3(0.10)	1084	1066(98.34)	9(0.84)
2013	5251	3759(71.59)	1(0.03)	1550	1548(99.87)	16(1.03)
2014	5057	4186(82.78)	2(0.05)	2181	2179(99.91)	37(1.70)
2015	4592	4177(90.96)	5(0.12)	2991	2903(97.06)	25(0.86)
2016	4618	4330(93.76)	3(0.07)	3762	3719(98.86)	25(0.67)
2017	4729	4155(87.86)	2(0.05)	4659	4639(99.57)	19(0.41)
2018	4455	4057(91.07)	9(0.22)	5517	5514(99.95)	26(0.47)
2019	4916	4728(96.18)	4(0.08)	6224	6197(99.57)	39(0.63)
2020	4795	4612(96.18)	9(0.20)	7061	7006(99.22)	32(0.46)
合计	48617	38990(80.20)	39(0.10)	35955	35381(98.40)	241(0.68)

年份	合计	性别		年龄组(岁)
年份	合计	男性	女性	≤24	25~44	45~64	≥65
2011	14(5.00)	13(92.86)	1(7.14)	0(0.00)	11(78.57)	3(21.43)	0(0.00)
2012	12(4.29)	10(83.33)	2(16.67)	2(16.67)	6(50.00)	4(33.33)	0(0.00)
2013	17(6.07)	12(70.59)	5(29.41)	1(5.88)	12(70.59)	4(23.53)	0(0.00)
2014	39(13.93)	32(82.05)	7(17.95)	9(23.08)	21(53.84)	9(23.08)	0(0.00)
2015	30(10.71)	29(96.67)	1(3.33)	0(0.00)	10(33.33)	17(56.67)	3(10.00)
2016	28(10.00)	22(78.57)	6(21.43)	0(0.00)	16(57.14)	10(35.72)	2(7.14)
2017	21(7.50)	18(85.71)	3(14.29)	1(4.76)	10(47.62)	7(33.33)	3(14.29)
2018	35(12.50)	30(85.71)	5(14.29)	8(22.86)	13(37.14)	4(11.43)	10(28.57)
2019	43(15.36)	39(90.70)	4(9.30)	4(9.30)	18(41.86)	15(34.89)	6(13.95)
2020	41(14.64)	35(85.37)	6(14.63)	4(9.76)	14(34.15)	18(43.90)	5(12.19)
总计	280(100.00)	240(85.71)	40(14.29)	29(10.36)	131(46.78)	91(32.50)	29(10.36)

年份	芙蓉区	天心区	岳麓区	开福区	雨花区	长沙县	望城区	宁乡市	浏阳市
2011	3(21.43)	2(14.29)	1(7.14)	3(21.43)	2(14.29)	1(7.14)	0(0.00)	1(7.14)	1(7.14)
2012	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	7(58.33)	1(8.33)	0(0.00)	4(33.34)
2013	1(5.88)	0(0.00)	0(0.00)	0(0.00)	4(23.53)	1(5.88)	3(17.65)	3(17.65)	5(29.41)
2014	1(2.56)	1(2.56)	2(5.13)	8(20.51)	0(0.00)	2(5.13)	6(15.39)	13(33.33)	6(15.39)
2015	1(3.33)	0(0.00)	1(3.33)	2(6.68)	0(0.00)	6(20.00)	3(10.00)	1(3.33)	16(53.33)
2016	1(3.57)	0(0.00)	0(0.00)	4(14.29)	0(0.00)	6(21.43)	5(17.85)	4(14.29)	8(28.57)
2017	2(9.52)	0(0.00)	2(9.52)	3(14.29)	1(4.76)	7(33.34)	1(4.76)	2(9.52)	3(14.29)
2018	7(20.00)	1(2.86)	1(2.86)	9(25.71)	0(0.00)	4(11.43)	2(5.71)	5(14.29)	6(17.14)
2019	1(2.33)	3(6.98)	4(9.30)	3(6.98)	0(0.00)	8(18.60)	1(2.33)	8(18.60)	15(34.88)
2020	3(7.32)	2(4.88)	3(7.31)	4(9.76)	0(0.00)	4(9.76)	7(17.07)	9(21.95)	9(21.95)
合计	20(7.14)	9(3.21)	14(5.00)	36(12.86)	7(2.50)	46(16.43)	29(10.36)	46(16.43)	73(26.07)