西安市2015—2018年青少年结核病患者耐药特征

Drug resistance of adolescent tuberculosis patients in Xi′an, 2015-2018

目的了解西安市青少年结核病原发性耐药和获得性耐药情况,为制定青少年群体结核病防治模式及策略提供依据。方法收集2015—2018年在西安市胸科医院及雁塔区、长安区结核门诊进行治疗的556名34岁以下耐药结核病患者资料,分析异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)4种一线抗结核药物耐药率及青少年耐药流行病学特点。结果农民和家政服务、家务、待业人员依然是耐药结核病高发群体,学生患病比例由5.41%上升到11.06%,干部职员的患病比例由10.81%上升到12.98%。结核病耐药患者中,青少年所占比例由2016年的63.68%降为2018年的46.01%,差异具有统计学意义(P=0.000)。青少年耐药群体中原发性结核病耐药患者比例逐渐升高,由54.05%上升到68.27%,差异具有统计学意义(P=0.019)。原发性耐药和获得性耐药中耐药比例占前3位的分别为HRS、HERS和HR,原发性和获得性耐药耐HRS比例为49.86%和49.74%,耐HERS比例分别为36.01%和37.44%,耐HR比例为9.14%和7.18%。结论西安市2015—2018年青少年结核病耐药比例持续下降,但原发性耐药比例不断上升,达到获得性耐药2倍水平。青少年耐药类别以HRS为主,占耐药类别一半比例。

Objective To understand the primary drug resistance and acquired drug resistance of adolescent tuberculosis in Xi'an,and provide the basis for the prevention and treatment model and strategy of adolescent tuberculosis.Methods From 2015 to 2018,the data were collected of 556 drug-resistant tuberculosis patients under 34 years old who were treated in Xi'an Chest Hospital and Yanta District and Chang'an District TB Clinic.The drug resistance rates of first-line drugs such as Isoniazid(H),Rifampicin(R),Streptomycin(S),Ethambutol(E)and the epidemiological characteristics of drug resistance among adolescents were analyzed.Results The farmers,domestic service workers and unemployed people were still the groups with high incidence of drug-resistant tuberculosis.The proportion of students with TB increased from 5.41%to 11.06%,and the proportion of cadres and staff with TB increased from 10.81%to 12.98%.Among patients with drug resistance to tuberculosis,the proportion of adolescents decreased from 63.68%to 46.01%,and the difference was statistically significant(P=0.000).The proportion of drug-resistant primary tuberculosis patients increased gradually from 54.05%to 68.27%.The difference was statistically significant(P=0.019).HRS,HERS and HR accounted for the top three of primary and acquired resistance respectively.The proportion of primary and acquired resistance to HRS were 49.86%and 49.74%,the proportion of resistance to HERS were 36.01%and 37.44%,the proportion of resistance to HR were 9.14%and 7.18%,respectively.Conclusion From 2015 to 2018,the proportion of drug resistance to tuberculosis among adolescents in Xi'an City continued to decline,but the proportion of primary drug resistance continued to rise,reached 2 times level of acquired drug resistance.HRS was the main drug-resistant category among adolescents,accounting for half of the drug-resistant categories.