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中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (1): 25-30.doi: 10.3969/j.issn.1000-6621.2014.01.006

• 论著 • 上一篇    下一篇

2007—2012年上海市结核病耐药趋势分析

李静 张阳奕 武洁 江渊 王莉莉 郁晨蕾 沈鑫   

  1. 200336 上海市疾病预防控制中心结核病防治科
  • 收稿日期:2013-09-05 出版日期:2014-01-10 发布日期:2014-01-05
  • 通信作者: 沈鑫 E-mail:xshen@scdc.sh.cn
  • 基金资助:

    上海市自然科学基金(11ZR1430900)；上海市卫生系统优秀青年人才培养计划(XYQ2011051)；上海市卫生局课题(20114073)

Trends of drug-resistant tuberculosis in Shanghai from 2007 to 2012

LI Jing, ZHANG Yang-yi, WU Jie, JIANG Yuan, WANG Li-li, YU Chen-lei, SHEN Xin   

  1. Department of Tuberculosis Prevention and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
  • Received:2013-09-05 Online:2014-01-10 Published:2014-01-05
  • Contact: SHEN Xin E-mail:xshen@scdc.sh.cn

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摘要： 目的 回顾性分析2007—2012年上海市结核病耐药情况及流行趋势。方法 收集2007—2012年上海市结核病新登记患者的痰培养阳性菌株12221株，进行一线抗结核药物（异烟肼、利福平、链霉素、乙胺丁醇）敏感性试验和菌种鉴定，对鉴定为结核分枝杆菌复合群的10979株菌株进行药敏结果分析，分析耐药情况及流行趋势，采用多因素logistic回归模型分析影响耐药和耐多药的相关因素。结果 10979株结核分枝杆菌总耐药率为23.0%(2522/10979)，初治患者耐药率为20.4%(1981/9702)，复治患者耐药率为42.4%(541/1277)；总耐多药率为5.3%(587/10979)，初治患者耐多药率为3.4%(328/9702)，复治患者耐多药率为20.3%(259/1277)。近6年总耐药率和复治患者耐药率均无上升趋势（χ2趋势值分别是2.38和0.23，P值均>0.05）；初治患者耐药率有上升趋势（χ2趋势=9.02，P<0.05），总耐多药率、初治和复治患者耐多药率均无上升趋势（χ2趋势值分别为0.33、1.67、0.48，P值均>0.05）。多因素logistic回归分析显示，复治患者更易产生耐药(OR=3.080，95%CI＝2.717~3.492，P<0.05)和耐多药(OR=7.781，95%CI＝6.481~9.341，P<0.05)，41~≤60岁年龄组患者与耐药（OR=1.270,95%CI＝1.045~1.544，P<0.05）和耐多药（OR=1.669,95%CI＝1.064~2.620，P<0.05）有关。结论 2007—2012年上海市结核病总耐药率和总耐多药率无上升趋势，复治与耐药和耐多药有显著相关。

关键词: 结核, 抗药性, 细菌, 上海市

Abstract: Objective To analyze the status and epidemic trend of anti-tuberculosis (TB) drug resistance in Shanghai from 2007—2012.  Methods 12221 new registered and sputum culture-positive cases in Shanghai during 2007—2012 were enrolled. Isolates obtained from each case were tested for susceptibility to first-line anti-TB drugs (INH, RFP, S and EMB) and species identification. The drug susceptibility testing result and demographic data of 10979 tuberculosis strains were used to analyze the status and trend of anti-TB drug resistance. Logistic regression model was used to determine the risk factors of drug resistance and multidrug-resistance.  Results The overall drug resistance rate was 23.0% (2522/10979), the total multidrug-resistance rate was 5.3% (587/10979), the initial drug and multidrug-resistance rate were 20.4% (1981/9702) and 3.4% (328/9702), and the acquired drug and multidrug-resistance rate were 42.4% (541/1277) and 20.3% (259/1277), respectively. There was no significant increase in total drug resistance (χ2=2.38, P>0.05), acquired drug resistance (χ2=0.23, P>0.05), total multidrug-resistance (χ2=0.33, P>0.05), initial multidrug-resistance (χ2=1.67, P>0.05) and acquired multidrug-resistance (χ2=0.48, P>0.05) in recent 6 years. The initial drug resistance rate significantly increased during 2007—2012 (χ2=9.02, P<0.05). The multivariate logistic regression analysis showed that the history of previous treatment for TB (OR=3.080, 95%CI＝2.717-3.492, P<0.05 and OR=7.781, 95%CI＝6.481-9.341, P<0.05) and age(41~≤60) (OR=1.270, 95%CI＝1.045-1.544, P<0.05 and OR=1.669, 95%CI＝1.064-2.620, P<0.05) were significantly associated with any drug and multidrug-resistance.  Conclusion There was no significant increase in total drug resistance rate and total multidrug-resistance rate. The history of previous treatment for TB is significantly associated with any drug and multidrug-resistance.

Key words: Tuberculosis, Drug resistance, bacterial, Shanghai city

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