上海市静安区2010—2014年结核杆菌耐药状况及传播特征研究

Study on the drug resistance and transmission characteriatics of mycobacterium tuberculosis in Jing′an district of Shanghai

目的了解上海市静安区结核病传播特征及结核分枝杆菌耐药情况,为制定有针对性的结核病控制策略提供依据。方法选择上海市疾病预防控制中心菌株库保存的2010-2014年静安区结核病患者菌株,通过药物敏感性试验和可变数目串联重复序列分型,最后纳入70株菌株进行耐药、VNTR基因型分型结果分析。结果总耐药率为30.00%(21/70),总耐多药率为15.71%(11/70),单耐药率为12.86%(9/70),多耐药率为1.43%(1/70)。无单耐利福平和单耐乙胺丁醇。初治与复治患者、男性与女性患者、<65岁与≥65岁患者耐药率和耐多药率差异无统计学意义(P>0.05)。70株菌株共得到57种VNTR基因型,其中50例患者的分离株为单一基因型,其他20例患者的菌株可归入7个基因簇,总成簇率为28.57%(20/70),同簇病例中有2簇存在家庭内接触,有5簇居住地间的直线距离在1.7km以内。耐多药菌株成簇率高于全敏感结核菌株(χ~2=9.406,P=0.004),差异有统计学意义。结论上海市静安区结核分枝杆菌的耐多药率较高,结核病患者中存在一定比例的近期传播,耐多药肺结核近期传播程度较高,高于全敏感结核。

Objective To discuss the drug resistance and transmission characteristics of Mycobacterium tuberculosis in Jing′an district of Shanghai,and to provide basis for disease prevention and control. Methods 70 bacteria strains isolated from TB patients and stored in the bacteria strain bank of Shanghai Municipal Center for Disease Control and Prevention from 2010 to 2014 in Jing′an district were selected for the analysis of drug resistance and VNTR genotype through variable number tandem repeats and drug sensitivity test. ResultsThe overall drug resistance rate of mycobacterium was 30.00% with the multi-drug resistance rate of 15.71%,the single drug-resistance rate of 12.86% and the poly-resistance rate of 1.43%,respectively.No strain was found to be single-resistant to RFP or EMB.The differences of the overall drug-resistance rate and multi-drug resistance rate were not statistically significant among strains isolated from initial TB or recurrent TB patients,only single genotype was found in each of 50 strains,and strains isolated from 20 patients clustered into 7 genotypes.Patients from two clusters had close contact and patients from 5clusters lived within 1.7km distance.Strains isolated from multi-drug resistance TB patients were more likely to be clustered compared to those from drug sensitive TB patients（χ^2=9.406,P=0.004）. Conclusions The multi-drug resistance rate of mycobacterium tuberculosis is high in Jing′an district of Shanghai,it is speculated that direct transmission of tuberculosis exists in Jing′an,and usually happens among patients with multi-drug resistance TB.