青岛市五区(市)结核病耐药情况分析

doi:10.3969/j.issn.1000-6621.2018.06.010

摘要/Abstract

摘要： 目的

基于青岛市五区(市)结核病耐药性的流行现状和数据进行分析,为制定有针对性的化疗方案和耐药结核病控制策略提供科学依据。

方法

对2012年1月至2013年12月期间青岛市五区(市)(黄岛区、平度市、即墨区、胶南市、胶州市)新登记的926例涂阳肺结核患者进行流行病学调查(简称“流调”),对患者痰标本进行分枝杆菌培养分离并进行比例法药物敏感性试验(简称“药敏试验”);排除基线信息缺失患者的菌株,共获得痰培养阳性患者临床分离株490株,剔除菌株污染等原因无法进行耐药分析的153株,对337株进行药敏试验,并将患者分为初治与复治两类进行统计分析。使用SPSS 20.0统计软件,基本情况采用描述性分析方法;计数资料采用χ ²检验或Fisher精确检验,检验水准α=0.05。

结果

五区(市)总的耐药率为19.88%(67/337),单耐药率为11.87%(40/337),多耐药率为2.97%(10/337),耐多药率为5.04%(17/337);初治和复治患者多耐药率(2.19%,7/319;16.67%,3/18)和耐多药率(4.08%,13/319;22.22%,4/18)比较差异均有统计学意义(Fisher精确检验,P=0.012,0.009);337株结核分枝杆菌药敏试验中,一线抗结核药物耐药率顺序为耐H 41例(12.17%),耐R 31例(9.20%)、耐Sm 19例(5.64%)、耐E 8例(2.37%)。67例耐药患者中,共有11种耐药谱,构成比较高的为耐H(22.39%)、耐R(19.40%)和耐H+R(19.40%);其中初治患者中耐药率较高的为耐H(21.67%,13/60)、耐R(20.00%,12/60)、耐H+R(20.00%,12/60),复治患者中耐药率最高的为耐H(28.57%,2/7)。单耐利福平肺结核患者占19.40%(13/67),耐多药肺结核患者占25.37%(17/67)。

结论

青岛五区(市)近年的结核病防控工作取得了一定的成效,但耐多药结核病疫情仍然严峻。

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

Abstract: Objective

Based on the current epidemic situation and the collected data on drug resistant tuberculosis (TB) in the 5 districts of Qingdao city, to conduct analysis and provide scientific evidences for the formulation of targeted chemotherapy regimens and drug-resistant TB control strategy.

Methods

An epidemiological investigation was conducted among 926 smear positive pulmonary TB patients, who were newly registered from January 2012 to December 2013 in the 5 districts (Huangdao, Pingdu, Jimo, Jiaonan and Jiaozhou) of Qingdao City. The sputum culture and drug susceptibility testing (DST) by using proportion method were performed to all recruited patients. Finally, a total of 490 patients were culture positive and had completely baseline information; among them, the strains from 337 patients were performed DST while the DST was failed to be done to the strains from 153 patients due to contaminations. We divided the patients into two category groups: initiated treatment patient group and re-treatment patient group, the analysis were done in the two patient groups. SPSS 20.0 was used for statistical analysis. The basic information analysis was conducted by using the prescription method. The count data were analyzed by using χ ² test or Fisher exact test, and the level of the test was α=0.05.

Results

The overall drug resistant TB rate in the 5 districts was 19.88% (67/337), the overall mono-drug resistant TB rate was 11.87% (40/337), the overall poly-drug resistant TB rate was 2.97% (10/337), and the overall multidrug-resistant (MDR) TB rate was 5.04% (17/337). The poly-drug resistant rates in the initiated treatment patient group (2.19%, 7/319) and retreatment patient group (16.67%, 3/18) were significantly different (Fisher exact test, P=0.012); the MDR rates in the initiated treatment patient group (4.08%, 13/319) and the re-treatment patient group (22.22%, 4/18) had statistically significant difference (Fisher exact test, P=0.009). In this study, the DST results of 337 strains showed the drug-resistant rates to the first-line anti-TB drugs as follows which ranked from high to low: H resistant rate (12.17%, 41/337), R resistant rate (9.20%, 31/337), S resistant rate (5.64%, 19/337) and E resistant rate (2.37%, 8/337). Among 67 TB patients with drug resistance, there were 11 drug resistance spectrums with a high proportion of H resistance (22.39%), R resistance (19.40%) and H+R resistance (19.40%); in the initiated treatment patient group, the higher drug resistant rate was to H (21.67%, 13/60), R (20.00%, 12/60), H+R (20.00%, 12/60), and in the re-treatment patient group, the higher drug resistant rate was to H (28.57%, 2/7). 19.40% (13/67) of patients was with rifampicin resistant, and the proportion of patients with MDR-TB was 25.37% (17/67).

Conclusion

The TB control program in Qingdao has achieved certain success, but the MDR-TB situation is still a serious problem.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistance, Microbial susceptibility testing, Data interpretation, statistical

任志盛,代晓琦,王忠东,孙海燕,张华强,薛白. 青岛市五区(市)结核病耐药情况分析[J]. 中国防痨杂志, 2018, 40(6): 599-603. doi: 10.3969/j.issn.1000-6621.2018.06.010

Zhi-sheng REN,Xiao-qin DAI,Zhong-dong WANG,Hai-yan SUN,Hua-qiang ZHANG,Bai XUE. Analysis of drug-resistant tuberculosis situation in 5 districts of Qingdao city[J]. Chinese Journal of Antituberculosis, 2018, 40(6): 599-603. doi: 10.3969/j.issn.1000-6621.2018.06.010

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基本情况	例数	构成比(%)
性别
男	261	77.45
女	76	22.55
年龄组(岁)
0~	17	5.04
20~	103	30.56
40~	109	32.34
≥60	108	32.06
职业
农民	280	83.09
学生	15	4.45
其他^a	42	12.46
教育程度
文盲/半文盲	71	21.07
小学	74	21.96
初中	118	35.01
高中及以上	74	21.96
家庭年收入(元)
0~	42	12.46
2500~	62	18.40
4200~	164	48.66
20000~	33	9.80
50000~	20	5.93
拒绝回答	16	4.75
患者登记分类
初治	319	94.66
复治	18	5.34

药物类别	初治(319例)		复治(18例)		合计(337例)		P值^a
药物类别	耐药株数	耐药率(%)	耐药株数	耐药率(%)	耐药株数	耐药率(%)	P值^a
H	33	10.34	8	44.44	41	12.17	<0.001
R	25	7.84	6	33.33	31	9.20	0.003
Sm	14	4.39	5	27.78	19	5.64	0.002
E	5	1.57	3	16.67	8	2.37	0.006

耐药类型药物	初治患者(60例)		复治患者(7例)		合计(67例)
耐药类型药物	耐药株数	耐药率(%)	耐药株数	耐药率(%)	耐药株数	耐药率(%)
单耐药
H	13	21.67	2	28.57	15	22.39
R	12	20.00	1	14.29	13	19.40
E	4	6.67	0	0.00	4	5.97
Sm	7	11.67	1	14.29	8	11.94
多耐药
R+Sm	0	0.00	1	14.29	1	1.49
H+E	0	0.00	1	14.29	1	1.49
H+Sm	7	11.67	1	14.29	8	11.94
耐多药
H+R	12	20.00	1	14.29	13	19.40
H+R+E	1	1.67	1	14.29	2	2.99
H+Sm+R	0	0.00	1	14.29	1	1.49
H+R+Sm+E	0	0.00	1	14.29	1	1.49