关键词: 结核,肺, 利福平, 抗药性, 微生物, 登记, 治疗结果

Abstract:

Objective: To compare and analyze the detection and treatment of rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients in Guangzhou during the “12th Five-Year Plan” and “13th Five-Year Plan” periods, and provide scientific basis for further development of RR-PTB prevention and control programme in Guangzhou. Methods: Data on RR-PTB patients registered in Guangzhou from January 1, 2011, to December 31, 2020 (“12th Five-Year Plan” (2011—2015) and “13th Five-Year Plan” (2016—2020)) were extracted from the “Tuberculosis Information Management System” subsystem of the “Chinese Center for Disease Control and Prevention Information System”. The data includes gender, age, ethnicity, occupation, residence registration, drug-resistant type, treatment category and other relevant information. RR-PTB cases were enrolled. Patient registration, population characteristics, drug-resistance screening and treatment outcomes for RR-PTB cases were analyzed. Results: From 2011 to 2020, the average annual registration rate of RR-PTB patients was 0.71/100000 (1152/162.8608 million), increasing from 0.31/100000 (42/13.4632 million) in 2011 to 0.38/100000 (60/15.9495 million) in 2015 and 0.97/100000 (182/18.7403 million) in 2020, and showing a gradual upward trend ($\chi_{\text {trend }}^{2}$=256.395, P<0.001). During the “12th Five-Year Plan” period, the average annual registration rate was 0.34/100000 (250/73.5806 million), with no statistically significant differences in registration rates between different years ($\chi_{\text {trend }}^{2}$=4.674, P=0.322). During the “13th Five-Year Plan” period, the average annual registration rate was 1.01/100000 (902/89.2802 million), with statistically significant differences in registration rates between different years ($\chi_{\text {trend }}^{2}$=38.439, P<0.001). Among the 1152 patients, the majority were males (851 cases, 73.87%), aged 25-34 years (257 cases, 22.31%), and housekeeping work or unemployment individuals (364 cases, 31.60%). The proportion of migrants, newly diagnosed cases, RR-PTB cases (excluding isoniazid-resistant cases), and extensively drug-resistant pulmonary tuberculosis increased from 8.80% (22/250), 11.20% (28/250), 0.00% (0/250), and 0.00% (0/250) during the “12th Five-Year Plan” period to 54.43% (491/902), 37.14% (335/902), 19.84% (179/902), and 0.78% (7/902) during the “13th Five-Year Plan” period, respectively, all showing statistically significant differences (χ²=91.370, 298.740, 97.915, 34.096, Ps<0.001). The screening rate of drug-resistant pulmonary tuberculosis in high-risk groups increased from 60.91% (148/243) in 2017 to 98.95% (568/574) in 2020, the screening rate of newly diagnosed/initially treated bacteriologically confirmed pulmonary tuberculosis increased from 83.93% (1410/1680) in 2018 to 94.99% (3222/3392) in 2020, and the differences were statistically significant ($\chi_{\text {trend }}^{2}$=425.043, 269.670, Ps<0.001). The proportion of patients who were enrolled for RR-PTB treatment, completed of treatment, and successfully treated increased from 81.20% (203/250), 2.46% (5/203), and 45.81% (93/203) during the “12th Five-Year Plan” period to 91.02% (821/902), 33.62% (276/821), and 67.48% (554/821) during the “13th Five-Year Plan” period, respectively. The proportion of treatment failure patients decreased from 17.73% (36/203) to 2.68% (22/821), with statistically significant differences (χ²=19.112, 86.809, 46.636, 58.572, Ps<0.001). Conclusion: Significant achievements have been made in the prevention and control of RR-PTB in Guangzhou during the “12th Five-Year Plan” and “13th Five-Year Plan” periods. In the next step, we need to continue to adhere to the principles of government leadership, multi-sector cooperation, and broad social participation, effectively implementing the requirements of the tuberculosis prevention and control programme, and strengthen the construction of the tuberculosis prevention and control service system.

Key words: Tuberculosis, pulmonary, Rifampicin, Drug resistance, microbial, National health programs, Registries, Treatment outcome