广西壮族自治区边境与非边境地区耐药肺结核疫情及其影响因素

doi:10.3969/j.issn.1000-6621.2019.05.017

摘要/Abstract

摘要：

目的分析广西壮族自治区(简称“广西”)边境与非边境地区耐药肺结核疫情及其影响因素。方法于2016年2月至2017年6月,选取广西境内东、西、南、北、中5个地区的桂林、贵港、崇左、百色和防城港5个市作为研究点。其中,与越南接壤的百色、崇左、防城港3个市作为边境组,未与越南接壤的桂林、贵港2个市作为非边境组。将研究期间内在调查点登记治疗、痰涂片阳性且分离培养出结核分枝杆菌的肺结核患者纳入研究,并采用比例法对患者的临床分离株进行药物敏感性试验,分析两组患者的耐药情况。研究共纳入患者1306例,其中边境组631例,非边境组675例。采用单因素及多因素logistic回归分析两组患者产生耐药的影响因素。结果边境组的总耐药率(18.1%,114/631)、单耐药率(9.5%,60/631)、多耐药率(2.7%,17/631)和耐多药率(5.9%,37/631),高于非边境组的总耐药率(11.1%,75/675)、单耐药率(7.7%,52/675)、多耐药率(1.8%,12/675)、耐多药率(1.6%,11/675),且总耐药率和耐多药率在两组间的差异有统计学意义( $χ 总耐药 2$ =12.75, $χ 耐多药 2$ =16.52,P值均<0.05);多因素logistic回归分析结果显示,边境地区和非边境地区的耐药影响因素均为患者类型,复治是两地肺结核患者发生耐药的危险因素,其OR值在边境地区为1.86(95%CI:1.13~3.05;Wald χ ²=5.97,P=0.015),在非边境地区为2.72(95%CI:1.39~5.33;Wald χ ²=8.45,P=0.004)。结论广西边境地区耐药肺结核疫情较非边境地区严峻,两地区发生耐药的影响因素均为复治。

关键词: 结核, 肺, 结核, 抗多种药物性, 小地区分析, 因素分析, 统计学

Abstract:

Objective To explore the epidemic and influencing factors of drug-resistant tuberculosis in border and non-border area of Guangxi.Methods From February 2016 to June 2017, five cities including Guilin, Guigang, Chongzuo, Baise and Fangchenggang located on East, West, South, North and Central of Guangxi were selected as the research sites. Among them, three cities including Baise, Chongzuo and Fangchenggang bordering Vietnam were in the border group, and the other two cities, Guilin and Guigang, which are not bordering Vietnam, were in the non-border group. Tuberculosis patients registered at the survey site during the study, positive for sputum smear and isolated Mycobacterium tuberculosis, were included in the study. Proportional method was used to test drug resistance of the clinical isolates in two groups. A total of 1306 patients were enrolled in the study, including 631 in the border group and 675 in the non-border group. Univariate and multivariate logistic regression were used to analyze influencing factors of drug resistance in the two groups.Results The rates of total drug resistance (18.1%, 114/631), single drug resistant (SDR) (9.5%,60/631), poly-drug resistant (PDR) (2.7%,17/631) and multidrug resistant (MDR) (5.9%,37/631) in the border group are higher than those in the non-border group ((11.1%,75/675), (7.7%,52/675), (1.8%,12/675), and (1.6%,11/675), respectively). The differences of the total resistance rate and MDR rate were statistically significant between the two groups ( $χ total 2$ =12.75, $χ MDR 2$ =16.52, Ps<0.05). Results of multivariate logistic regression analysis showed that the influencing factor of tuberculosis resistance in border areas and non-border areas were patient types, and retreatment was a risk factor for drug resistance in tuberculosis patients in two groups. The OR values were 1.86 (95%CI: 1.13-3.05, Wald χ ²=5.97, P=0.015) in the border group and 2.72 (95%CI: 1.39-5.33, Wald χ ²=8.45, P=0.004) in the non-border group. Conclusion The drug resistance rate of tuberculosis patients in border area is higher than that in non-border area in Guangxi, retreatment was the influencing factor of drug resistance in both regions.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Small-area analysis, Factor analysis, statistical

龙茜,林玫,蓝如束,崔哲哲,梁大斌,林定文,罗丹,叶婧,覃慧芳,黄莉雯,黄敏莹. 广西壮族自治区边境与非边境地区耐药肺结核疫情及其影响因素[J]. 中国防痨杂志, 2019, 41(5): 564-568. doi: 10.3969/j.issn.1000-6621.2019.05.017

Xi LONG,Mei LIN,Ru-shu LAN,Zhe-zhe CUI,Da-bin LIANG,Ding-wen LIN,Dan LUO,Jing YE,Hui-fang QIN,Li-wen HUANG,Min-ying HUANG. Epidemic and influencing factors of drug-resistant tuberculosis in border and non-border area of Guangxi[J]. Chinese Journal of Antituberculosis, 2019, 41(5): 564-568. doi: 10.3969/j.issn.1000-6621.2019.05.017

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参考文献 19

[1]	黄曙海, 蓝如束, 刘飞鹰 , 等. 广西壮族自治区肺结核耐药性调查及复治患者耐药相关因素分析. 中国防痨杂志, 2013,35(9):711-717.
[2]	赵雁林, 逄宇 . 结核病实验室检验规程.北京: 人民卫生出版社, 2015: 45-53.
[3]	刘二勇, 周林, 王黎霞 . 《WS 196—2017结核病分类》标准全面解读. 中国防痨杂志, 2018,40(3):234-238. doi: 10.3969/j.issn.1000-6621.2018.03.003 URL
[4]	World Health Organization . Global tuberculosis report 2018. Geneva:World Health Organization, 2018.
[5]	白大鹏, 孔伟利, 张丽霞 . 2006-2017年天津市结核分枝杆菌耐药性分析. 中华医院感染学杂志, 2019,29(3):346-350.
[6]	Nhung NV, Hoa NB, Sy DN , et al. The fourth national anti-tuberculosis drug resistance survey in Viet Nam. Int J Tuberc Lung Dis, 2015,19(6):670-675. doi: 10.5588/ijtld.14.0785 URL pmid: 25946357
[7]	巫株华, 黎贞燕, 李宇轩 , 等. 广东省2911例涂阳肺结核病患者的耐药疫情分析. 广东医学, 2018,39(2):228-234. doi: 10.3969/j.issn.1001-9448.2018.02.016 URL
[8]	沈欣, 雷世光, 宋沈超 , 等. 2015年贵州省肺结核患者耐药监测情况分析. 临床肺科杂志, 2017,22(5):781-784. doi: 10.3969/j.issn.1009-6663.2017.05.002 URL
[9]	杨星, 陈连勇, 马利 , 等. 2012-2014年云南省结核分枝杆菌耐药分析. 现代预防医学, 2016,43(12):2263-2266,2279.
[10]	刘彬彬, 胡培磊, 龚道方 , 等. 湖南省涂阳肺结核患者结核分枝杆菌耐药谱及其影响因素. 中国感染控制杂志, 2016,15(2):73-78. doi: 10.3969/j.issn.1671-9638.2016.02.001 URL
[11]	高会霞, 侯军良, 张志 , 等. 346例肺结核患者结核分枝杆菌耐药性调查及耐多药结核病影响因素分析. 中国防痨杂志, 2015,37(11):1130-1135. doi: 10.3969/j.issn.1000-6621.2015.11.010 URL
[12]	刘彬彬, 胡培磊, 龚道方 , 等. 湖南省涂阳肺结核患者结核分枝杆菌耐药谱及其影响因素. 中国感染控制杂志, 2016,15(2):73-78. doi: 10.3969/j.issn.1671-9638.2016.02.001 URL
[13]	Yang C, Luo T, Shen X , et al. Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a retrospective observational study using whole-genome sequencing and epidemiological investigation. Lancet Infect Dis, 2017,17(3):275-284.
[14]	Ullah I, Javaid A, Tahir Z , et al. Pattern of Drug Resistance and Risk Factors Associated with Development of Drug Resis-tant Mycobacterium tuberculosis in Pakistan. PLoS One, 2016,11(1):e0147529.
[15]	Zhang C, Wang Y, Shi G , et al. Determinants of multidrug-resistant tuberculosis in Henan province in China: a case control study. BMC Public Health, 2016,16:42. doi: 10.1186/s12889-016-2711-z URL pmid: 4715352
[16]	梁立波, 李玲, 孙宏 , 等. 耐多药结核流行及影响因素研究进展. 中国公共卫生, 2014,30(9):1221-1225. doi: 10.11847/zgggws2014-30-09-37 URL
[17]	张国钦, 钟达 . 耐药肺结核发生和流行的危险因素. 中国慢性病预防与控制, 2017,25(7):557-560. doi: 10.16386/j.cjpccd.issn.1004-6194.2017.07.023 URL
[18]	Alene KA, Yi H, Viney K , et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis, 2017,17(1):573. doi: 10.1186/s12879-017-2662-8 URL pmid: 28814276
[19]	Zumla A, George A, Sharma V , et al. The WHO 2014 global tuberculosis report-further to go. The Lancet Global Health, 2015,3(1):e10-e12.

变量	赋值
是否耐药	敏感=0;耐药=1
性别	女=1;男=2
年龄组	0~岁=1;31~岁=2;61~92岁=3
现住址	城镇=1;农村=2
民族	汉族=1;壮族=2;其他=3
职业	农民=1;其他=2
家庭年收入	≤20000元=1;>20000元=2
文化水平	初中以下=1;初中及以上=2
患者类型	初治=1;复治=2
累及肺野数	≤3个肺野=1;>3个肺野=2
有无空洞	肺部无空洞=1;肺部有空洞=2

药敏试验结果	合计(1306株)		边境组(631株)		非边境组(675株)		χ²值	P值
药敏试验结果	菌株数	耐药率(%)	菌株数	耐药率(%)	菌株数	耐药率(%)	χ²值	P值
任一耐H	111	8.5	68	10.8	43	6.4	8.14	0.004
任一耐R	65	5.0	53	8.4	12	1.8	30.24	<0.001
任一耐E	32	2.5	16	2.5	16	2.4	0.04	0.847
任一耐S	72	5.5	41	6.5	31	4.6	2.27	0.132
任一耐Km	6	0.5	4	0.6	2	0.3	0.24	0.623
任一耐Ofx	36	2.8	22	3.5	14	2.1	2.43	0.119

影响因素	边境组					非边境组
影响因素	例数	耐药例数	耐药率 (%)	χ²值	P值	例数	耐药例数	耐药率 (%)	χ²值	P值
性别				1.12	0.290				0.01	0.922
女	122	18	14.8			150	17	11.3
男	509	96	18.9			525	58	11.0
年龄组(岁)				0.95	0.623				2.38	0.304
0~	87	13	14.9			112	12	10.7
31~	365	70	19.2			334	43	12.9
61~	179	31	17.3			229	20	8.7
现住址				0.13	0.720				0.01	0.918
城镇	109	21	19.3			132	15	11.4
农村	522	93	17.8			543	60	11.1
民族				0.55	0.759				1.42	0.491
汉族	118	19	16.1			603	64	10.6
壮族	493	92	18.7			53	8	15.1
其他^a	20	3	15.0			19	3	15.8
职业				0.01	0.932				0.14	0.710
农民	500	90	18.0			538	61	11.3
其他^b	131	24	18.3			137	14	10.2
家庭年收入(元)				3.35	0.067				0.17	0.685
≤20000	278	59	21.2			221	23	10.4
>20000	353	55	15.6			454	52	11.5
文化水平				2.22	0.137				0.69	0.408
初中以下	276	57	20.7			282	28	9.9
初中及以上	355	57	16.1			393	47	12.0
患者类型				6.10	0.014				9.06	0.003
初治	530	87	16.4			619	62	10.0
复治	101	27	26.7			56	13	23.2
累及肺野数(个)				2.52	0.112				2.29	0.130
≤3	297	46	15.5			289	26	9.0
>3	334	68	20.4			386	49	12.7
有无空洞				1.90	0.168				0.67	0.414
无	252	39	15.5			250	31	12.4
有	379	75	19.8			425	44	10.4

地区	因素	β值	s_$\bar{x}$值	Wald χ²值	P值	OR值(95%CI值)
边境组	患者类型	0.62	0.25	5.97	0.015	1.86(1.13~3.05)
	常量	-1.63	0.12	192.65	0.000
非边境组	患者类型	1.00	0.34	8.45	0.004	2.72(1.39~5.33)
	常量	-2.20	0.13	268.90	0.000