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中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (1): 62-69.doi: 10.19982/j.issn.1000-6621.20230323

• 论著 • 上一篇    下一篇

2019—2021年南京地区成人活动性肺结核合并糖尿病患者表型耐药特征分析

郭晶1, 庞加磊2, 高卫卫1, 蔡敏3, 林霏申1(), 张侠1()   

  1. 1南京中医药大学附属南京医院(南京市第二医院)结核科,南京 211132
    2南京脑科医院重症医学科,南京 210029
    3南京中医药大学附属南京医院(南京市第二医院)机构办,南京 211132
  • 收稿日期:2023-09-04 出版日期:2024-01-10 发布日期:2024-01-04
  • 通信作者: 张侠,Email:zhangxia365@sina.com;林霏申,Email:feishenlin1974@sina.com
  • 基金资助:
    南京市卫生科技发展专项资金项目(YKK19113)

Phenotypic drug resistance spectrum analysis of adult patients with active pulmonary tuberculosis complicated with diabetes mellitus in Nanjing from 2019 to 2021

Guo Jing1, Pang Jialei2, Gao Weiwei1, Cai Min3, Lin Feishen1(), Zhang Xia1()   

  1. 1Department of Tuberculosis, the Second Hospital of Nanjing/Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 211132, China
    2Department of Intensive Care Unit, Nanjing Brain Hospital, Nanjing 210029, China
    3Department of Institutional Office, the Second Hospital of Nanjing/Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 211132, China
  • Received:2023-09-04 Online:2024-01-10 Published:2024-01-04
  • Contact: Zhang Xia, Email: zhangxia365@sina.com;Lin Feishen, Email: feishenlin1974@sina.com
  • Supported by:
    Nanjing Health Science and Technology Development Special Fund(YKK19113)

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摘要：

目的：分析南京地区成人活动性肺结核合并糖尿病患者表型耐药谱,为该类人群的结核病防控提供依据。方法：采用回顾性研究方法,收集2019—2021年南京市第二医院2089例成人分枝杆菌分离培养阳性肺结核患者临床分离菌株及临床资料,依据是否合并糖尿病将患者分为肺结核合并糖尿病患者(共病组;544例)和非糖尿病肺结核患者(非共病组;1545例),通过年龄、性别、体质量指数(BMI)、抗结核治疗史进行1∶2病例匹配后最后纳入共病组541例,非共病组881例。分析两组患者耐药谱,以及共病组不同血糖控制水平人群的耐药谱及其耐药顺位。结果：共病组左氧氟沙星耐药率[13.1%(71/541)]、利福平敏感异烟肼耐药结核病(hr-TB)耐药率[10.5%(57/541)]和准广泛耐药结核病(pre-XDR-TB)耐药率[6.8%(37/541)]均高于非共病组[分别为8.9%(78/881)、7.5%(66/881)和4.1%(36/881)],差异均有统计学意义(χ2=6.516,P=0.011;χ2=3.932,P=0.047;χ2=5.216,P=0.022)。初治共病组hr-TB耐药率[9.4%(41/436)]高于非共病组[6.3%(45/717)],复治共病组左氧氟沙星和pre-XDR-TB耐药率[分别为38.1%(40/105)和25.7%(27/105)]均高于非共病组[分别为22.6%(37/164)和14.0%(23/164)],差异均有统计学意义(χ2=3.842,P=0.049;χ2=7.561,P=0.006;χ2=5.781,P=0.016)。共病组初治空腹血糖不达标患者异烟肼单耐药率[12.8%(24/187)]和hr-TB耐药率[12.8%(24/187)]均高于空腹血糖达标患者[分别为6.4%(16/249)和6.8%(17/249)],差异均有统计学意义(χ2=5.264,P=0.022;χ2=4.523,P=0.033)。共病组初治和复治患者耐药顺位均为异烟肼[15.1%(66/436)和44.8%(47/105)]>左氧氟沙星[7.1%(31/436)和38.1%(40/105)]>利福平[6.4%(28/436)和36.2%(38/105)]>乙胺丁醇[2.1%(9/436)和16.2%(17/105)],且初治患者的hr-TB耐药率[9.4%(41/436)]高于耐多药率[5.7%(25/436)],差异有统计学意义(χ2=4.196,P=0.041)。结论：南京地区活动性肺结核合并糖尿病成人患者中异烟肼相关耐药率增加,需尽早对初治肺结核合并糖尿病和空腹血糖控制不达标患者启动异烟肼耐药筛查。

关键词: 结核,肺, 糖尿病, 结核,抗多种药物性, 人群监测

Abstract:

Objective: To analyze the phenotypic drug resistance spectrum of adult patients with active pulmonary tuberculosis (PTB) complicated with diabetes mellitus in Nanjing, and to provide evidence for the prevention and control of tuberculosis. Methods: A retrospective study was conducted. The clinical isolates and data of 2089 adult PTB patients with culture positive were collected from the Second Hospital of Nanjing from 2019 to 2021. The patients were divided into PTB patients complicated with diabetes mellitus (comorbidity group; 544 cases) and non-diabetic PTB patients (non-comorbidity group; 1545 cases). After 1∶2 case matching by age, sex, body mass index (BMI), and history of anti-tuberculosis treatment, a total of 541 cases in the comorbidity group and 881 cases in the non-comorbidity group were included. The drug resistance spectrum of the two groups were analyzed, as well as the drug resistance spectrum and ranking of drug resistance in the comorbidity group with different levels of blood glucose. Results: The drug resistance rates of levofloxacin (13.1% (71/541)), rifampicin-susceptible and isoniazid-resistant tuberculosis (hr-TB, 10.5% (57/541)), and pre-extensive drug-resistant tuberculosis (pre-XDR-TB, 6.8% (37/541)) in the comorbidity group were higher than those in the non-comorbidity group (8.9% (78/881), 7.5% (66/881), and 4.1% (36/881)), and the differences were statistically significant (χ2=6.516, P=0.011; χ2=3.932, P=0.047; χ2=5.216, P=0.022). The resistance rate of hr-TB in the newly diagnosed comorbidity group (9.4% (41/436)) was higher than that in the non-comorbidity group (6.3% (45/717)), and the resistance rates of levofloxacin and pre-XDR-TB in the comorbidity group for retreatment cases (38.1% (40/105) and 25.7% (27/105)) were higher than those in the non-comorbidity group (22.6% (37/164) and 14.0% (23/164)), and the differences were statistically significant (χ2=3.842, P=0.049; χ2=7.561, P=0.006; χ2=5.781, P=0.016). The rates of isoniazid mono-resistance (12.8% (24/187)) and hr-TB (12.8% (24/187)) were higher in patients with uncontrolled fasting blood glucose than in those with controlled fasting blood glucose (6.4% (16/249) and 6.8% (17/249)) in the newly diagnosed comorbidity group, the differences were statistically significant (χ2=5.264, P=0.022; χ2=4.523, P=0.033). The drug resistance ranking in both the newly diagnosed and retreatment cases in the comorbidity group was isoniazid (15.1% (66/436) and 44.8% (47/105))>levofloxacin (7.1% (31/436) and 38.1% (40/105))>rifampicin (6.4% (28/436) and 36.2% (38/105))>ethambutol (2.1% (9/436) and 16.2% (17/105)). The drug resistance rate of hr-TB (9.4% (41/436)) in the newly diagnosed comorbidity group was higher than that of multidrug-resistant tuberculosis (MDR-TB)(5.7% (25/436)), and the difference was statistically significant (χ2=4.196, P=0.041). Conclusion: The rate of isoniazid-related resistance in adults with active PTB together with diabetes in Nanjing is increasing, especially in patients with newly diagnosed tuberculosis, and it is necessary to initiate isoniazid-resistance screening in patients with newly treated PTB complicated with diabetes mellitus and poor fasting blood glucose control as soon as possible.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Tuberculosis, multidrug-resistant, Population surveillance

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