吉林市结核分枝杆菌耐药情况及趋势预测分析

doi:10.19982/j.issn.1000-6621.20240470

摘要/Abstract

摘要：

目的: 分析近年吉林市肺结核患者耐药情况及变化趋势。方法: 采用回顾性研究方法,参照入组标准收集2023年1月至2024年6月吉林市结核病医院收治的796例菌阳肺结核患者基本信息和痰标本结核分枝杆菌药物敏感性试验(简称“药敏试验”)结果,分析吉林市肺结核患者耐药情况,并对不同类型耐药情况进行时间序列趋势预测分析。结果: 2023年1月至2024年6月,796例患者对16种抗结核药物的总耐药率为43.59%(347/796),其中,耐多药率、单耐药率、多耐药率、准广泛耐药率分别为14.82%(118/796)、9.30%(74/796)、2.01%(16/796)、5.90%(47/796),未发现广泛耐药患者。对16种抗结核药物的任一药物耐药率高于10%的顺位依次为:链霉素(26.26%,209/796)>异烟肼(23.87%,190/796)>利福平(18.84%,150/796)>利福布汀(14.70%,117/796)>左氧氟沙星(13.57%,108/796)>莫西沙星(12.31%,98/796)>帕司烟肼(11.43%,91/796)。老年组单耐药率[13.20%(45/341)]高于中年组[5.86%(17/290)]和青年组[7.27%(12/165)],青年组和中年组耐多药率[20.00%(33/165)和18.97%(55/290)]均高于老年组[8.80%(30/341)],青年组和中年组准广泛耐药率[7.88%(13/165)和10.00%(29/290)]均高于老年组[2.05%(7/341)],差异均有统计学意义(χ²=11.009,P=0.004;χ²=17.248,P<0.001;χ²=18.204,P<0.001)。复治患者的耐多药率[28.02%(72/257)]和准广泛耐药率[14.79%(38/257)]均高于初治患者[分别为8.53%(46/539)和2.03%(11/539)],差异均有统计学意义(χ²=52.307,P<0.001;χ²=48.934,P<0.001)。对趋势预测的时间序列分析结果显示:2024年7—12月吉林市单耐药率、多耐药率、耐多药率和准广泛耐药率分别为6.67%、 0.78%、11.92%和4.02%。结论: 吉林市2023年1月至2024年6月肺结核患者各种类型耐药率均处于较高水平,预测2024年7—12月不同耐药类型的耐药率均呈下降趋势,但耐多药和准广泛耐药仍处于较高水平,故应加强对耐药肺结核患者防控管理,实时监测链霉素、异烟肼、利福平、利福布汀、左氧氟沙星等药物的使用及耐药情况,特别是老年患者单耐药和中青年患者耐多药的耐药数据,以降低耐多药及准广泛耐药的比例。

关键词: 结核, 抗多种药物性, 药物监测, 模型, 统计学, 预测, 传染病控制

Abstract:

Objective: To analyze the drug resistance status and change trend among pulmonary tuberculosis (PTB) patients in Jilin City in recent years. Methods: A retrospective study was conducted, basic information and drug susceptibility test (DST) result of Mycobacterium tuberculosis from samples of 796 sputum-positive PTB patients admitted to Jilin City Tuberculosis Hospital between January 2023 and June 2024 were collected according to inclusion criteria. Their drug resistance status was analyzed, and time-series trend prediction was performed for different types of drug resistance. Results: From January 2023 to June 2024, the overall drug resistance rate to 16 anti-tuberculosis drugs among 796 patients was 43.59% (347/796). The rates of multidrug resistance (MDR), mono-drug resistance, poly-drug resistance, and pre-extensive drug resistance (pre-XDR) were 14.82% (118/796), 9.30% (74/796), 2.01% (16/796), and 5.90% (47/796), respectively. No extensively drug-resistant (XDR) cases were detected. The drugs with a resistance rate exceeding 10% were ranked as follows: streptomycin (26.26%, 209/796)>isoniazid (23.87%, 190/796)>rifampicin (18.84%, 150/796)>rifabutin (14.70%, 117/796)>levofloxacin (13.57%, 108/796)>moxifloxacin (12.31%, 98/796)>pasiniazide (11.43%, 91/796). The mono-drug resistance rate in the elderly group (13.20%, 45/341) was higher than that in the middle-aged group (5.86%, 17/290) and the young group (7.27%, 12/165). The MDR rates in the young group (20.00%, 33/165) and middle-aged group (18.97%, 55/290) were higher than that in the elderly group (8.80%, 30/341). Pre-XDR rates in the young group (7.88%, 13/165) and middle-aged group (10.00%, 29/290) were also higher than that in the elderly group (2.05%, 7/341). All differences were statistically significant (χ²=11.009, P=0.004; χ²=17.248, P<0.001; χ²=18.204, P<0.001). MDR (28.02%, 72/257) and pre-XDR rates (14.79%, 38/257) were higher in retreatment patients than in new patients (8.53% (46/539) and 2.03% (11/539), respectively), with statistically significant differences (χ²=52.307, P<0.001; χ²=48.934, P<0.001). Time-series analysis predicted that drug resistance rates from July to December 2024 should be 6.67% for mono-drug resistance, 0.78% for poly-drug resistance, an increase in MDR to 11.92%, and a pre-XDR rate of 4.02%. Conclusion: Between January 2023 and June 2024, different kinds of drug resistance among PTB patients in Jilin City remained high. Predictions for July to December 2024 indicate MDR and pre-XDR levels remained high, however, all four types of resistance have a downward trend. Strengthened management and real-time monitoring of drug use and resistance to streptomycin, isoniazid, rifampicin, rifabutin, levofloxacin, and other drugs are necessary, especially for mono-drug resistance in elderly patients and MDR in young and middle-aged patients, to reduce the occurrence of MDR and pre-XDR cases.

Key words: Tuberculosis, multidrug-resistant, Drug monitoring, Models, statistical, Forecasting, Communicable disease control

中图分类号:

刘菊秀, 张建华, 温均筠, 姜晓双. 吉林市结核分枝杆菌耐药情况及趋势预测分析[J]. 中国防痨杂志, 2025, 47(3): 348-354. doi: 10.19982/j.issn.1000-6621.20240470

Liu Juxiu, Zhang Jianhua, Wen Junjun, Jiang Xiaoshuang. Analysis and trend prediction of Mycobacterium tuberculosis drug resistance in Jilin City[J]. Chinese Journal of Antituberculosis, 2025, 47(3): 348-354. doi: 10.19982/j.issn.1000-6621.20240470

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耐药类型	性别				年龄组
耐药类型	男性 (612例)	女性 (184例)	χ²值	P值	青年组 (165例)	中年组 (290例)	老年组 (341例)	χ²值	P值
单耐药	61(9.97)	13(7.07)	1.413	0.235	12(7.27)	17(5.86)	45(13.20)	11.009	0.004
多耐药	12(1.96)	4(2.17)	-	0.857^a	6(3.64)	6(2.07)	4(1.17)	3.434	0.180
耐多药	94(15.36)	24(13.04)	0.601	0.438	33(20.00)	55(18.97)	30(8.80)	17.248	<0.001
准广泛耐药	40(6.54)	9(4.89)	0.662	0.416	13(7.88)	29(10.00)	7(2.05)	18.204	<0.001

年/月	患者例数	单耐药	多耐药	耐多药	准广泛耐药
2023
1	17	3(17.65)	1(5.88)	3(17.65)	1(5.88)
2	18	1(5.56)	1(5.56)	4(22.22)	1(5.56)
3	44	5(11.36)	2(4.55)	7(15.91)	4(9.09)
4	70	5(7.14)	1(1.43)	12(17.14)	5(7.14)
5	63	6(9.52)	1(1.59)	10(15.87)	5(7.94)
6	57	1(1.75)	0(0.00)	8(14.04)	2(3.51)
7	29	6(20.69)	1(3.45)	3(10.34)	1(3.45)
8	70	5(7.14)	0(0.00)	6(8.57)	1(1.43)
9	43	6(13.95)	2(4.65)	3(6.98)	3(6.98)
10	31	4(12.90)	1(3.23)	3(9.68)	1(3.23)
11	36	1(2.78)	1(2.78)	5(13.89)	2(5.56)
12	27	4(14.81)	3(11.11)	4(14.81)	3(11.11)
2024
1	56	7(12.50)	0(0.00)	20(35.71)	8(14.29)
2	61	6(9.84)	0(0.00)	9(14.75)	5(8.20)
3	40	4(10.00)	1(2.50)	6(15.00)	2(5.00)
4	53	7(13.21)	1(1.89)	7(13.21)	3(5.66)
5	38	1(2.63)	0(0.00)	4(10.53)	1(2.63)
6	43	2(4.65)	0(0.00)	4(9.30)	1(2.33)
合计	796	74(9.30)	16(2.01)	118(14.82)	47(5.90)