贵州省肺结核疫情控制主要影响因素分析

Major influencing factors of tuberculosis epidemic control in Guizhou province:an analysis on surveillance data of 2006-2017

目的分析贵州省流动人口、耐多药肺结核(MDR-TB)、结核/艾滋(TB/HIV)双重感染流行趋势,为控制疫情提供依据。方法流动人口监测时段为2011—2017年,MDR-TB监测时段为2012—2017年,TB/HIV双重感染监测时段为2006—2017年。收集肺结核报告发病相关信息,分析流动人口、MDR-TB、TB/HIV双重感染的流行情况,用百分率和χ~2检验进行统计学描述。结果流动人口结核病报告发病率从2011年的27.29/10万上升到2017年的30.03/10万,2015年最高时达32.95/10万(χ~2_(trend)=134.99, P<0.05),流动人口肺结核患者占全省肺结核患者总数的20%～25%; 7146例肺结核患者的总耐药率、耐多药率分别为23.34%、8.13%,初治患者和复治患者之间的总耐药率、耐多药率差别具有统计学意义(P<0.05);结核中艾滋感染率从2006年的0.22%上升到2017年的0.33%,最低为0.11%,平均为0.22%(χ~2_(trend)=41.34, P<0.05)。结论贵州流动人口肺结核报告发病率、耐多药率、TB/HIV双重感染率均成增长趋势,其中,流动人口所占权重大,需实施好流动人口肺结核患者的全程督导治疗,控制MDR、TB/HIV双重感染发展势头。

Objective To analyze the prevalence of pulmonary tuberculosis(TB), multidrug-resistant tuberculosis(MDRTB), and TB/human immunodeficiency virus(HIV) co-infection among general and migrant population in Guizhou province for providing evidences to the control of TB epidemic. Methods From National Tuberculosis Control Information System,we collected following surveillance data of Guizhou province: migrant population during 2011-2017, MDR-TB incidents during 2012-2017, and incidents of TB/HIV co-infection during 2006-2017. Percentage analysis and chi-square test were adopted in statistics analysis. Results The reported TB incidence rate in the migrant population increased from 27.29/100 000 in 2011 to 30.03/100 000 in 2017(χ^2trend=134.99, P < 0.05) and the highest rate was 32.95/100 000 in 2015. During the period, the yearly number of migrant active TB patients accounted for 20%-25% of the yearly number of total TB patients.Among the 7 146 TB patients with drug sensitivity test during the period, the total drug resistance rate and multidrug resistance rate were 23.34% and 8.13%, respectively, and there were significant differences in the total drug and multidrug resistance rate between the initial treatment and retreatment TB patients(both P < 0.05). The proportion of HIV infection among the all reported TB patients increased significantly from 0.22% in 2006 to 0.33% in 2017(χ^2trend=41.34, P < 0.05),with the lowest annual proportion of 0.11% and an overall increase of 0.22% during the period. Conclusion The reported TB incidence rate among migrant population, the rate of MDR-TB and the ratio of TB/HIV co-infection among the reported TB cases, and the proportion of migrant TB cases in all TB patients increased in Guizhou province from 2006 to 2017. The results suggest that full-course treatment under supervision should be strengthened among migrant TB patients and control the increase in MDR-TB and TB/HIV co-infection in the population.