深圳市2000—2016年初治耐药结核病流行趋势分析

Epidemic trend analysis of drug-resistant tuberculosis treated initially in Shenzhen,2000-2016

目的探讨深圳市初治耐药结核病流行趋势变化,为耐药结核病防控策略调整提供理论依据。方法对2000—2016年深圳市登记的所有涂阳肺结核病患者进行痰检,以罗氏培养阳性菌株进行菌型鉴定和耐药检测,采用Joinpoint regression program软件计算年度变化百分比并进行趋势检验。结果共检测17 857株结核分枝杆菌,其中初治单耐利福平733株(4.10%),初治单耐异烟肼1 457株(8.16%),初治同时耐异烟肼、利福平541株(3.03%)。2000—2006年深圳市初治利福平耐药结核分枝杆菌检出率以每年9.29%的平均速率下降(P=0.03);2007—2014年以每年0.72%的平均速率波动(P=0.06);2015—2016年以每年30.22%的平均速率下降(P=0.14);2000—2011年深圳市初治异烟肼耐药结核分枝杆菌检出率以每年4.22%的平均速率下降(P=0.01);2012—2014年以每年5.70%的平均速率上升(P=0.61);2015—2016年以每年18.25%的平均速率再次下降(P=0.36);2000—2008年深圳市初治同时对异烟肼、利福平耐药结核分枝杆菌检出率以每年1.94%的平均速率波动,呈下降趋势(P=0.57);2009—2011年以每年9.28%的平均速率下降(P=0.81);2012—2016年以每年8.39%的平均速率上升(P=0.58)。结论深圳市初治耐药结核病流行均呈阶段性变化,其中对利福平、异烟肼单耐药率在波动中呈下降趋势,而对利福平、异烟肼同时耐药率近年来呈上升趋势,主要原因为传播导致的原发性耐药增多,应该调整深圳市防控策略,把重点转移至加强耐药结核病传染源的隔离,特别是耐多药结核病患者。

Objective To explore the epidemic trend of drug-resistant tuberculosis （TB） treated initially in Shenzhen City, so as to provide the reference for improving the control and prevention strategy of TB. Methods The bacterial type identification and drug-resistance detection were used to all the patients with smear positive pulmonary TB registered in Shenzhen City from 2000 to 2016. The trends of drug resistance of Mycobacterium tuberculosis and annual percent changes （APC） were analyzed by Joinpoint regression program. Results A total of 17 857 strains of M. tuberculosis were detected, and among them, 733 strains （4.10%）of rifampicin resistance, 1 457 strains （8.16%）of isoniazid resistance, and 541 strains （3.03%）of multidrug resistance. The rate of rifampicin resistance was decreased with an annual percent change （APC） by 9.29% from 2000 to 2006 （P=0.03）, and fluctuated with an APC by 0.72% from 2007 to 2014 （P=0.06）. From 2015 to 2016, the average rate was decreased again with an APC by 30.22% （P=0.14）. The isoniazid resistance rate of M. tuberculosis was decreased with an APC by 4.22% from 2000 to 2011 （P=0.01）, and then increased with an APC by 5.70% from 2012 to 2014 （P=0.61）. From 2015 to 2016, the average rate was decreased again with an APC by 18.25% （P=0.36）. The multidrug resistance rate of M. tuberculosis was fluctuated with an APC by 1.94% from 2000 to 2008, showing a downward trend （P=0.57）. From 2009 to 2011, the rate was decreased with an APC by 9.28% （P=0.81）, and increased with an APC by 8.39% from 2012 to 2016 （P=0.58）. Conclusions The isoniazid and rifampicin drug resistance rates of M. tuberculosis in Shenzhen City have changed in stages. The single drug resistance rates of rifampicin and isoniazid show a downward trend in fluctuation. In recent years, the multidrug resistance rates have been increasing, which is mainly caused by primary resistance. Therefore, the prevention and control strategies should be adjusted, and the detection of TB patients and the management of infection source should be strengthened.