Email Alert | 帮助

结核病与肺部健康杂志 ›› 2019, Vol. 8 ›› Issue (4): 265-271.doi: 10.3969/j.issn.2095-3755.2019.04.007

• 论著 • 上一篇    下一篇

2012—2018年大连市肺结核患者耐药状况分析

蔡春葵,吕欣桐,李刚,孙诗学,顾晓峰,许岩,王颖,于洋,路希维()   

  1. 116031 辽宁省大连市结核病医院
  • 收稿日期:2019-11-11 出版日期:2019-12-30 发布日期:2019-12-30
  • 通信作者: 路希维 E-mail:yiluxiwei@126.com
  • 基金资助:
    大连市科技创新基金(2018J13SN110)

Analysis of drug resistance of tuberculosis patients in Dalian from 2012 to 2018

Chun-kui CAI,Xin-tong LYU,Gang LI,Shi-xue SUN,Xiao-feng GU,Yan XU,Ying WANG,Yang YU,Xi-wei LU()   

  1. Dalian Tuberculosis Hospital,Liaoning Province,Dalian 116031,China
  • Received:2019-11-11 Online:2019-12-30 Published:2019-12-30
  • Contact: Xi-wei LU E-mail:yiluxiwei@126.com

RichHTML

7

PDF (PC)

742

摘要：

目的 分析2012—2018年大连市结核病耐药情况。方法 从《中国疾病预防控制信息系统》平台上的《结核病信息管理系统》中搜集2012—2018年大连市新登记的涂阳且行痰培养(改良罗氏培养法)的5512例肺结核患者,其中5241例(95.1%)培养阳性的患者均行菌种鉴定和抗结核药物敏感性试验(简称“药敏试验”),获得结核分枝杆菌(MTB)5050株(96.4%,5050/5241)、非结核分枝杆菌(NTM)191株(3.6%,191/5241)。对鉴定为MTB菌株的药敏试验结果进行耐药情况分析。采用SPSS 13.0软件对计数资料或各年度耐药率进行χ 2检验或 χ 趋势 2 检验,并以线性回归方程进行耐药率、耐多药率与年份、初复治情况的耐药趋势验证,均以P<0.05为差异有统计学意义。结果 大连市结核病总耐药率、总耐多药率、初治耐药率、初治耐多药率、复治耐药率、复治耐多药率分别从2012年的64.5%(223/346)、34.7%(120/346)、46.6%(34/73)、23.3%(17/73)、69.2%(189/273)、37.7%(103/273)逐年下降至2018年的24.0%(176/733)、6.7%(49/733)、19.0%(99/522)、4.8%(25/522)、36.5%(77/211)、11.4%(24/211),均呈明显下降趋势( χ 趋势 2 =213.930、223.357、40.371、49.536、86.323、66.990,P值均=0.000)。线性回归方程结果显示总耐药率与年份、初复治情况呈下降趋势(P耐药=0.000;P耐多药=0.000)。 5050株送检的MTB临床分离株对INH、RFP、Sm、Ofx、Km、EMB等抗结核药品的总耐药率分别为19.2%(970/5050)、17.8%(900/5050)、8.9%(447/5050)、10.3%(521/5050)、4.8%(243/5050)、2.5%(124/5050)。1623株耐药菌株共有46种耐药组合,其中单药耐药6种,占总耐药谱的45.3%(735/1623),以耐INH最高(13.3%,216/1623);耐多药(含广泛耐药)16种,占总耐药谱的36.8%(598/1623),以耐INH+RFP最高(13.3%,216/1623);多耐药24种,占总耐药谱的17.9%(290/1623),以耐INH+Sm最高(4.0%,65/1623)。结论 2012—2018年大连市结核病总耐药率、总耐多药率呈明显下降趋势,对耐多药结核病系统治疗管理后的防控效果显著。

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

Abstract:

Objective To analyze the drug resistance of tuberculosis (TB) in Dalian from 2012 to 2018.Methods Based on China Information System of Disease Prevention and Control, a total of 5512 TB patients newly registered with smear-positive and sputum culture (modified Roche culture method) were collected from TB Information Management System in Dalian from 2012 to 2018. Among these patients, 5241 (95.1%) patients with positive culture were subjected to strain identification and anti-TB drugs sensitivity test (referred to as “drug susceptibility test”). Finally, 5050 strains of Mycobacterium tuberculosis (MTB) (96.4%, 5050/5241) and 191 strains of non-tuberculosis mycobacteria (NTM) (3.6%, 191/5241) were obtained. The drug resistance of the strain identified as MTB was analyzed based on drug susceptibility test results. SPSS 12.0 software was used to conduct Chi-square test or Chi-square trend test on the counting data or the annual drug resistance rate, and the linear regression equation was used to verify the drug resistance rate, multidrug resistance rate, year and the situation of the initial treatment or the retreatment. P<0.05 was considered as a statistically significant difference.Results The total drug resistant rate, total multidrug resistant rate, drug resistant rate of the initial treatment, multidrug resistant rate of the initial treatment, resistant rate of the retreatment, and multidrug resistant rate of the retreatment in Dalian were, respectively, 64.5% (223/346), 34.7% (120/346), 46.6% (34/73), 23.3% (17/73), 69.2% (189/273), and 37.7% (103/273) in 2012, while which were dropped to 24.0% (176/733), 6.7% (49/733), 19.0% (99/522), 4.8% (25/522), 36.5% (77/211), and 11.4% (24/211) in 2018, showing a significant downward trend ( χ trend 2 =213.930, 223.357, 40.371, 49.536, 86.323, 66.990, all P values =0.000). The results of the linear regression equation showed that the total drug resistant rate, year and the condition of initial treatment and retreatment showed a decreasing trend (Presistance=0.000, Pmultidrug resistance=0.000). The total resistant rate of the 5050 strains to INH, RFP, Sm, Ofx, Km, EMB were, respectively, 19.2% (970/5050), 17.8% (900/5050), 8.9% (447/5050), 10.3% (521/5050), 4.8% (243/5050), and 2.5% (124/5050). There were 46 combinations of drug resistance in 1623 strains, including 6 kinds of single drug resistance, accounting for 45.3% (735/1623) of the total drug resistance spectrum, with the highest INH resistance (13.3%, 216/1623); 16 kinds of multidrug resistance (including extensive drug resistance), accounting for 36.8% (598/1623) of the total drug resistance spectrum, with the highest resistance to INH + RFP (13.3%, 216/1623); 24 kinds of multidrug resistance, accounting for 17.9% (290/1623) of the total drug resistance spectrum, with the highest resistance to INH + Sm (4.0%, 65/1623).Conclusion From 2012 to 2018, the total drug resistance rate and the total multidrug resistance rate of TB showed a significant downward trend in Dalian. The treatment and management of MDR-TB system exerts the remarkable prevention and control effects.

Key words: Tuberculosis,pulmonary, Microbial sensitivity tests, Tuberculosis,multidrug-resistant, Data interpretation,statistical, Small-area analysis

版权所有 © 2021 《中国防痨杂志》期刊社　 京ICP备11029069号-3   京公安网备11010202008787号
ip访问总数:  ip当日访问总数:  当前在线人数:
本作品遵循Creative Commons Attribution 3.0 License授权许可