上海市静安区2010-2015年肺结核传播状况及影响因素分析

Recent transmission of pulmonary tuberculosis and its influencing factors in Jing＇ an district,Shanghai, 2010-2015

目的了解上海市静安区肺结核传播状况及其影响因素。方法收集2010-2015年上海市静安区结核病定点医院诊治的肺结核患者中分离到的结核分枝杆菌进行药物敏感性试验，采用12个位点（QUB11b、QUB18、Mtub21、Miru26、QUB26、Mtub04、Miru31、Miru40、VNTR2372、VNTR3820、3232、4120）结核分枝杆菌可变数目串联重复序列（MIRU-VNTR）多态性分析，结合现场流行病学调查，分析结核分枝杆菌的成簇特征及其影响因素。结果80株结核分枝杆菌菌株总耐药率为28.75%（23/80），总耐多药率为16.25%（13/80）。MIRU-VNTR基因型分型结果显示，58例患者的分离株为单一基因型（72.50%，58/80），22例为成簇菌株，成簇比为27.50%（22/80），共分7个簇，每簇含2-10例菌株。结核分枝杆菌近期传播影响多因素分析结果显示，耐多药（OR=35.799，95%CI：4.239-302.346）和合并症（OR=7.695，95%CI：1.421-41.658）与近期传播有关。成簇病例的现场流行病学调查发现，1个簇患者含有10例耐多药结核病患者（MDR-TB），9例患者相互间认识，有确定的联系，1例患者有可能的联系。结论2010－2015年上海市静安区肺结核患者中存在一定比例的近期传播，耐多药和合并症是结核病近期传播的重要危险因素。

Objective To understand the recent transmission of Mycobacterium tuberculosis （MTB）, and to identify the influencing factors of recent transmission among pulmonary tuberculosis （TB） patients in Jing’an district, Shanghai.Methods The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing’an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat （MIRU-VNTR）（QUB11b, QUB18, Mtub21, Miru26, QUB26, Mtub04, Miru31, Miru40, VNTR2372, VNTR3820, 3232, 4120）, and tested for drug susceptibility as well. With the results of field epidemiological investigation, univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission.Results This study enrolled 80 TB patients, 23 （28.75%） had a resistance to at least one anti-TB drug, and the prevalence of multidrug-resistant tuberculosis （MDR-TB） was 16.25%. A total of 65 genotypes were identified with 58 （72.50%, 58/80） being unique and 7 clusters with 2-10 isolated in each cluster. The proportion of clustering was 27.50% （22/80）. Results from the multivariate analysis revealed that multidrug- resistance （OR=35.799, 95%CI： 4.239-302.346） and having comorbidity with TB （OR=7.695, 95%CI： 1.421-41.658） were independently associated with the clustering, which suggesting a recent transmission. The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links, one was between family members, and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them.Conclusion Recent transmission of tuberculosis happened among TB patients in Jing’an district, with high risks among the MDR-TB patients.