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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (11): 1141-1147.doi: 10.19982/j.issn.1000-6621.20220268

• 论著 • 上一篇    下一篇

我国结核病耐药状况: 2018年全国结核病耐药监测数据分析

王胜芬, 周杨, 欧喜超, 夏辉, 赵冰, 宋媛媛, 郑扬, 杜昕, 赵雁林()   

  1. 中国疾病预防控制中心结核病预防控制中心,北京 102206
  • 收稿日期:2022-07-20 出版日期:2022-11-10 发布日期:2022-11-03
  • 通信作者: 赵雁林
  • 基金资助:

Prevalence of drug resistant tuberculosis in China: data from national drug resistant tuberculosis survey in 2018

Wang Shengfen, Zhou Yang, Ou Xichao, Xia Hui, Zhao Bing, Song Yuanyuan, Zheng Yang, Du Xin, Zhao Yanlin()   

  1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2022-07-20 Online:2022-11-10 Published:2022-11-03
  • Contact: Zhao Yanlin
  • Supported by:
    Central Government Funds for Tuberculosis Prevention and Control Project-Daily Operation(228711)


目的: 分析我国2018年结核病耐药流行状况,为结核病治疗和防控政策的制定提供参考。方法: 沿用2007—2008年全国结核病耐药性基线调查抽取的70个调查点作为监测点,以2018年新诊断的涂阳肺结核患者为研究对象,采用统一的信息表收集研究对象的社会人口学特征、病史和治疗用药史等信息;同时,在监测点采集可疑肺结核患者的痰标本并进行涂片和培养,阳性分离菌株送至省、市级疾病预防控制中心或结核病防治机构进行菌种鉴定和药物敏感性试验(简称“药敏试验”)。考虑复杂抽样设计和抽样权重,采用SAS 9.4 survey procedures相关程序计算加权耐药率,以logistic 回归评估耐药率的变化。结果: 3820例新涂阳和643例复治涂阳患者纳入本研究。新涂阳患者、复治涂阳患者的利福平耐药率分别为5.08%(95%CI: 4.39%~5.77%)和 23.31%(95%CI: 20.14%~26.48%);新涂阳患者、复治涂阳患者的耐多药率分别为3.52%(95%CI: 2.94%~4.11%)和18.01%(95%CI: 15.36%~20.67%)。与基线调查相比,新涂阳患者[OR(95%CI)值为0.71 (0.58~0.87);P<0.001] 和复治涂阳患者[OR(95%CI)值为0.53 (0.41~0.68);P<0.001]的利福平耐药率较基线显著下降;新涂阳患者[OR(95%CI)值为0.53 (0.42~0.67);P<0.001]和复治涂阳患者[OR(95%CI)值为0.47 (0.36~0.61);P<0.001]的耐多药率较基线也显著下降。估计2018年登记的病原学阳性肺结核患者中,新涂阳患者、复治涂阳患者利福平耐药例数分别为12662例(95%CI:10942~14382)和8156例(95%CI:7047~9265)。结论: 2018年新涂阳和复治涂阳肺结核患者利福平耐药率、耐多药率较基线调查时均显著降低。但由于人口众多,我国耐药结核病总体负担仍然较重。建议采取综合措施以减少耐药结核病的产生和传播,进而降低我国耐药结核病总体负担。

关键词: 结核,肺, 分枝杆菌, 结核, 抗药性


Objective: The aim of this study is to analyze prevalence of drug resistant tuberculosis in China in 2018, and provide evidence for formulating policies about treatment and prevention of tuberculosis. Methods: The 70 clusters selected by the National Drug Resistant Tuberculosis Baseline Survey during 2007—2008 were used as survey sites, newly diagnosed smear positive pulmonary tuberculosis patients were recruited in this study in 2018. Standardized questionnaire was used to collect socio-demographic features, disease histories and medical treatment histories of these patients. Sputum samples were collected from presumptive pulmonary tuberculosis patients visiting the surveysites for smear and culture. Positive isolates were transferred to provincial or municipal Centers for Disease Control and Prevention or tuberculosis institutes for bacteria identification and drug susceptibility test. Survey procedures of SAS 9.4 software were used to calculate the weighted drug resistant prevalence considering the complex sampling design and sampling weight. Logistic regression model was used to assess changes in prevalence. Results: 3820 new smear positive pulmonary tuberculosis patients and 643 retreated smear positive patients were included in the survey. Prevalence of rifampicin resistant tuberculosis (RR-TB) was 5.08% (95%CI: 4.39%-5.77%) and 23.31% (95%CI: 20.14%-26.48%) in new cases and retreated patients, respectively. Multidrug resistant tuberculosis (MDR-TB) accounted for 3.52% (95%CI: 2.94%-4.11%) of new cases, and 18.01% (95%CI: 15.36%-20.67%) of retreated patients. Compared with the 2007—2008 baseline survey, the RR-TB prevalence in new cases (OR(95%CI): 0.71 (0.58-0.87);P<0.001) and retreated patients (OR(95%CI): 0.53 (0.41-0.68);P<0.001) decreased significantly. The MDR-TB prevalence of new cases (OR(95%CI): 0.53 (0.42-0.67);P<0.001) and retreated patients (OR(95%CI): 0.47 (0.36-0.61);P<0.001) also decreased significantly. It was estimated that the numbers of RR-TB patients were 12662 (95%CI: 10942-14382) and 8156 (95%CI: 7047-9265) among bacteriologically confirmed new cases and retreated patients nationwide in 2018. Conclusion: The prevalence of RR-TB and MDR-TB among new cases and retreated patients in 2018 decreased significantly while compared with that of the 2007—2008 baseline survey. However, due to the large number of population, China is still a country with high burden of drug resistant tuberculosis. It is suggested that comprehensive measures should be taken to reduce the emergence and spread of drug resistant tuberculosis, and then to reduce the overall burden of drug resistant tuberculosis in China.

Key words: Tuberculosis, pulmonary, Mycobacterium tuberculosis, Drug resistance