2016—2020年北京市确诊利福平耐药肺结核患者治疗及转归情况分析

doi:10.3969/j.issn.2096-8493.2021.02.013

摘要/Abstract

摘要：

目的分析2016—2020年北京市确诊利福平耐药肺结核患者治疗及转归情况,为完善北京市耐药肺结核防治策略提供依据。方法从《中国疾病预防控制信息系统》的子系统《结核病信息管理系统》获取2016—2020年北京市确诊登记的592例利福平耐药肺结核患者数据,采用描述性方法分析患者特征、治疗及转归情况。结果 2016—2020年北京市确诊的592例利福平耐药肺结核患者中,男性占69.43%(411/592);以25~64岁青壮年患者为主,占77.03%(456/592)。确诊利福平耐药患者的纳入治疗率逐年增加,由2016年的74.29%(52/70)增加至2020年的97.79%(133/136),呈上升趋势( $χ 趋势 2$ =44.831,P<0.001)。女性和户籍患者的纳入治疗率分别为96.69%(175/181)和94.55%(312/330),分别高于男性(90.27%,371/411)和非户籍患者(89.31%,234/262),差异均有统计学意义(χ²=7.221,P=0.007;χ²=5.580,P=0.018)。新患者的纳入治疗率为95.37%(391/410),高于登记分类为2或3个月末痰涂片阳性患者(68.18%,15/22)和复发患者(88.73%,126/142),差异有统计学意义(Fisher精确概率法,P<0.001)。开始治疗时间在2016—2018年间的228例利福平耐药患者的治疗成功率为81.58%(186/228);随着年龄的增加,治疗成功率由15~24岁组的8/8降低至65~93岁组的74.19%(23/31),差异有统计学意义( $χ 趋势 2$ =7.479,P=0.006)。结论 2016—2020年北京市确诊利福平耐药肺结核患者纳入治疗率逐年上升,治疗成功率维持在较高水平,需重点关注流动人口、男性利福平耐药患者的发现和治疗。

关键词: 结核,肺, 利福平, 药物耐受性, 治疗结果

Abstract:

Objective To analyze the treatment and outcomes of rifampicin-resistant pulmonary tuberculosis in Beijing from 2016 to 2020, so as to provide the basis for improving the prevention and control strategy of drug-resistant tuberculosis in Beijing. Methods Information of patients with rifampicin-resistant pulmonary tuberculosis was extracted from the “TB Management Information System”. Descriptive analysis was conducted to interpret patients’ characteristics, treatment and outcomes. Results From 2016 to 2020, a total of 592 patients with rifampicin-resistant pulmonary tuberculosis were notified in Beijing, 69.43% (411/592) of them were male, and 77.03% (456/592) were young adults aged 25-64 years. The treatment initiation rates of patients increased year by year, from 74.29% (52/70) in 2016 to 97.79% (133/136) in 2020 ( $χ trend 2$ =44.831, P<0.001). Treatment initiation rates of female and registered residents were 96.69% (175/181) and 94.55% (312/330), which were higher than those of male (90.27%, 371/411) and non-registered residents (89.31%, 234/262), and the differences were statistically significant (χ ²=7.221, P=0.007; χ ²=5.580, P=0.018). Treatment initiation rate of new patients was 95.37% (391/410), higher than patients classified as “sputum smear-positive at the end of 2nd and 3rd month” (68.18%, 15/22), recurrence (88.73%, 126/142), the difference was statistically significant (P<0.001, Fisher exact probability). The treatment success rate for the 228 patients with rifampicin resistance who started treatment before 2018 was 81.58% (186/228). The treatment success rate decreased with age increasing, from 8/8 in 15-24 years group to 74.19% (23/31) in 65-93 years group ( $χ trend 2$ =7.479, P=0.006). Conclusion From 2016 to 2020, the treatment initiation rate of patients with rifampicin-resistance pulmonary tuberculosis in Beijing increased year by year, and the treatment success rate was high. However, attention should be paid to the detection and treatment of migrant and male patients with rifampicin-resistance.

Key words: Tuberculosis, pulmonary, Rifampin, Drug tolerance, Treatment outcome

张红伟, 孙闪华, 高志东, 许琰, 陶荔莹, 陈曦. 2016—2020年北京市确诊利福平耐药肺结核患者治疗及转归情况分析[J]. 结核与肺部疾病杂志, 2021, 2(2): 164-168. doi: 10.3969/j.issn.2096-8493.2021.02.013

ZHANG Hong-wei, SUN Shan-hua, GAO Zhi-dong, XU Yan, TAO Li-ying, CHEN Xi. Treatment and outcomes of rifampicin-resistant pulmonary tuberculosis in Beijing, 2016—2020[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(2): 164-168. doi: 10.3969/j.issn.2096-8493.2021.02.013

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人口学特征	例数	构成比(%)
性别
男性	411	69.43
女性	181	30.57
年龄组(岁)
15~24	49	8.27
25~44	263	44.43
45~64	193	32.60
65~93	87	14.70
职业
家务及待业	202	34.12
干部职员	92	15.54
离退人员	79	13.34
农民	77	13.01
工人	55	9.29
餐饮及商业服务	44	7.43
人口学特征	例数	构成比(%)
学生、教师	20	3.38
其他	23	3.89
户籍类型
户籍	330	55.74
非户籍	262	44.26

分类	纳入治疗(546例)		未纳入治疗(46例)		χ²值	P值
分类	例数	构成比(%)	例数	构成比(%)	χ²值	P值
确诊年份					44.831^a	<0.001^a
2016	52	74.29	18	25.71
2017	42	80.77	10	19.23
2018	146	93.59	10	6.41
2019	173	97.19	5	2.81
2020	133	97.79	3	2.21
性别					7.221	0.007
男性	371	90.27	40	9.73
女性	175	96.69	6	3.31
年龄组(岁)					-^b	0.255
15~24	46	93.88	3	6.12
25~44	242	92.02	21	7.98
45~64	182	94.30	11	5.70
65~93	76	87.36	11	12.64
户籍类型					5.580	0.018
户籍	312	94.55	18	5.45
非户籍	234	89.31	28	10.69
跨区诊疗					26.439	<0.001
是	362	96.53	13	3.47
否	184	84.79	33	15.21
登记分类					-^b	<0.001
新患者	391	95.37	19	4.63
2或3个月末痰涂片阳性	15	68.18	7	31.82
复发	126	88.73	16	11.27
其他	14	77.78	4	22.22

类别	治疗成功(186例)		未治疗成功(42例)		χ²值	P值
类别	例数	构成比(%)	例数	构成比(%)	χ²值	P值
年龄组(岁)					7.479^a	0.006^a
15~24	8	8/8	0	0.00
25~44	100	87.72	14	12.28
45~64	55	73.33	20	26.67
65~93	23	74.19	8	25.81
性别					0.012	0.914
男性	130	81.76	29	18.24
女性	56	81.16	13	18.84
户籍类型					3.182	0.074
户籍	105	77.78	30	22.22
非户籍	81	87.10	12	12.90
跨区诊疗					0.030	0.862
是	109	81.95	24	18.05
否	77	81.05	18	18.95
诊疗单位					0.190	0.663
市级定点机构	131	80.86	31	19.14
区级定点机构	55	83.33	11	16.67