2014—2017年甘肃省结核分枝杆菌耐药监测结果分析

doi:10.3969/j.issn.1000-6621.2021.11.014

中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (11): 1183-1193.doi: 10.3969/j.issn.1000-6621.2021.11.014

2014—2017年甘肃省结核分枝杆菌耐药监测结果分析

李晴, 司红艳(), 马玲, 李银花, 辜吉秀, 王冬冬, 何健

730020 兰州,甘肃省疾病预防控制中心结核病防治所结核病参比实验室(李晴、司红艳、马玲、李银花、辜吉秀、王冬冬);甘肃省红十字血液中心办公室(何健)

收稿日期:2021-07-07 出版日期:2021-11-10 发布日期:2021-11-02
通信作者: 司红艳 E-mail:1134864781@qq.com
基金资助:
甘肃省卫生行业科研计划项目(GSWSKY-2014-23);甘肃省卫生行业科研计划项目(GSWSKY-2014-24);甘肃省自然科学基金项目(145RJZA148)

Analysis of drug resistant surveillance results of Mycobacterium tuberculosis in Gansu Province from 2014 to 2017

LI Qing, SI Hong-yan(), MA Ling, LI Yin-hua, GU Ji-xiu, WANG Dong-dong, HE Jian

Tuberculosis Reference Laboratory, Institute of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730020, China

Received:2021-07-07 Online:2021-11-10 Published:2021-11-02
Contact: SI Hong-yan E-mail:1134864781@qq.com

摘要/Abstract

摘要：

目的分析甘肃省肺结核患者结核分枝杆菌分离株耐药情况。方法 2014年9月1日至2017年8月31日,采用整群分层等比例随机抽样方法,选取甘肃省30家县级结核病定点诊疗机构作为监测点,排除痰涂片抗酸染色阴性且调查期间正在接受抗结核治疗或不同意接受调查的肺结核患者,对培养阳性的≥15岁的肺结核患者分离的1931株结核分枝杆菌分离株(初治患者分离株1815株,复治患者分离株116株)进行10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)、阿米卡星(Am)、氧氟沙星(Ofx)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸钠(PAS)]的比例法表型药物敏感性试验(简称“药敏试验”)。结果 1931株结核分枝杆菌分离株的总耐药率、耐多药率、单耐药率、多耐药率和广泛耐药率分别为26.26%(507/1931;95%CI:24.30%~28.22%)、8.44%(163/1931;95%CI:7.20%~9.68%)、11.39%(220/1931;95%CI:9.98%~12.81%)、6.42%(124/1931;95%CI:5.33%~7.51%)和0.41%(8/1931;95%CI:0.13%~0.70%)。其中,初、复治患者分离株的总耐药率[分别为25.45%(462/1815;95%CI:23.45%~27.46%)和38.79%(45/116;95%CI:30.10%~47.84%)]和耐多药率[分别为7.82%(142/1815;95%CI:6.59%~9.06%)和18.10%(21/116;95%CI:11.10%~25.11%)]差异均有统计学意义(χ²=5.357,P=0.021;χ²=11.623,P=0.001),且初治患者分离株在男性、中部地区的总耐药率[分别为26.22%(284/1083)和24.96%(158/633)]均明显低于复治患者分离株[分别为41.49%(39/94)和51.43%(18/35)],差异均有统计学意义(χ²=5.241,P=0.022;χ²=5.888,P=0.015)。对10种抗结核药品的总耐药率前3位依次为INH[16.78%(324/1931)]、EMB[15.38%(297/1931)]、RFP[10.10%(195/1931)]。据此估算,甘肃省每年新发耐药、耐多药、广泛耐药患者分别为2341~2764、665~940、5~70例。结论甘肃省结核病耐药情况严重,以一线抗结核药品耐药为主。同时,初治患者的耐药情况应引起重视。

关键词: 结核,肺, 结核,抗多种药物性, 药物敏感性试验, 耐药监测, 数据说明,统计

Abstract:

Objective To analyze the drug resistance of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Gansu Province. Methods A total of 30 county-level designated tuberculosis medical institutions in Gansu Province were selected as surveillance sites by means of cluster stratified equal proportion random sampling method. Between Sep 2014 and Aug 2017, 1931 isolates from sputum culture positive pulmonary tuberculosis patients older than 15 years were detected by the proportional phenotypic drug sensitivity test which reported results for ten anti-tuberculosis drugs (isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), amikacin (Am), ofloxacin (Ofx), capreomycin (Cm), isoniazid (Pto), and sodium p-aminosalicylate (PAS)). Results For the tested 1931 isolates, the overall resistance rate, multidrug-resistance rate, monoresistance rate, polydrug resistance rate, and widespread resistance rate was 26.26% (507/1931; 95%CI: 24.30%-28.22%), 8.44% (163/1931; 95%CI: 7.20%-9.68%),11.39% (220/1931; 95%CI: 9.98%-12.81%), 6.42% (124/1931; 95%CI: 5.33%-7.51%), and 0.41% (8/1931; 95%CI: 0.13%-0.70%), respectively. Among them, there were significant differences in the overall resistance rates (25.45% (462/1815; 95%CI: 23.45%-27.46%) and 38.79% (45/116; 95%CI: 30.10%-47.84%), respectively) and multidrug-resistance rates (7.82% (142/1815; 95%CI: 6.59%-9.06%) and 18.10% (21/116; 95%CI: 11.10%-25.11%), respectively) between isolates from initial-treatment and retreatment patients (χ ²=5.357,P=0.021;χ²=11.623,P=0.001); And the overall resistance rates of isolates from initial-treatment patients in males and central areas (26.22% (284/1083) and 24.96% (158/633), respectively) were significantly lower than those of isolates from retreatment patients (41.49% (39/94) and 51.43% (18/35), respectively), and the differences were statistically significant (χ²=5.241,P=0.022;χ²=5.888,P=0.015). The top three drug resistance rates to 10 anti-tuberculosis drugs were found to be INH (16.78%,324/1931), EMB (15.38%,297/1931), RFP (10.10%,195/1931). It is estimated that the number of new drug-resistant, multidrug-resistant and extensively drug-resistant patients in Gansu Province per year is 2341-2764, 665-940 and 5-70 respectively. Conclusion Drug resistance of tuberculosis is serious in Gansu Province, and the resistance to first-line anti-tuberculosis drugs is common. Furthermore, the drug resistance of newly treated patients should be paid more attention.

Key words: Tuberculosis,pulmonary, Tuberculosis,multi-drug resistant, Medicine sensitiveness test, Drug resistance monitoring, Data interpretation,statistical

李晴, 司红艳, 马玲, 李银花, 辜吉秀, 王冬冬, 何健. 2014—2017年甘肃省结核分枝杆菌耐药监测结果分析[J]. 中国防痨杂志, 2021, 43(11): 1183-1193. doi: 10.3969/j.issn.1000-6621.2021.11.014

LI Qing, SI Hong-yan, MA Ling, LI Yin-hua, GU Ji-xiu, WANG Dong-dong, HE Jian. Analysis of drug resistant surveillance results of Mycobacterium tuberculosis in Gansu Province from 2014 to 2017[J]. Chinese Journal of Antituberculosis, 2021, 43(11): 1183-1193. doi: 10.3969/j.issn.1000-6621.2021.11.014

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2014—2017年甘肃省结核分枝杆菌耐药监测结果分析

Analysis of drug resistant surveillance results of Mycobacterium tuberculosis in Gansu Province from 2014 to 2017

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