北京地区2008-2010年肺结核病复发流行病学和机制分析

Analysis of Epidemiology and Mechanism of Recurrent Tuberculosis in Beijing from 2008 to 2010

目的研究北京地区肺结核病的复发情况,确定复发病例中内源性复燃和外源性再感染的比例。方法对北京各区县随机收取的4694例肺结核病临床病例进行回顾性研究,从中筛选出治疗痊愈后,间断6个月以上再次ty院确定为复发的病例。对复发病例进行背景资料分析,分析和复发有关的风险因素;并且对复发病例临床分离株应用数目可变串联重复序列基因分型方法进行分析,确定复发形式。结果从4694例肺结核病临床病例中发现265例复发病例,复发率为6.7%;在复发风险上30~59岁年龄段和其他年龄段人群相比差异有统计学意义(OR=1.780,95%CI:1.406~2.255.P<0.05);复治患者和初治患者相比差异有统计学意义(OR=1.032,95%CI:1.010~1054,P<0.05)。配对的复发病例中64%(37/58)为内源性复发,36%(21/58)为外源性再感染。结论在北京地区30~59岁年龄段人群、初始入院为复治的患者更容易出现肺结核病复发;复发病例主要为内源性复燃,同时也存在一定的外源性再感染和近期传播。

Objctive To study the situation of recurrent tuberculosis in Beijing,and clarify the percentage of relapse and reinfection among recurrent tuberculosis.Methods A retrospective study was conducted,which included 4694 tuberculosis cases collected randomly from each districts and countries in Beijing.The patients who had experienced two tuberculosis treatment episodes,interval for at least six months,with cure being the outcorme of the first episode,were selected as recurrent cases.The data of recurrent tuberculosis cases were analyzed by statistical analysis,to seek the risk factors associated with recurrence.The type of recurrence tuberculosis clinical isolated strains was identified by variable number of tandem repeats.Results Tuberculosis recurred in 265 of the 4694 succesfully treated tuberculosis patients,the recurrence rate was 6.7%.Those people in the 30-59-year old group compared with other age group(OR=1.780,95%CI:1.406-2.255,P<0.05),and those retreated for pulmonary tuberculosis compared with primary treatment tuberculosis(OR=1.032,95%CI:1.010-1.054,P<0.05)were more likely to have tuberculosis recurrence.Among paired recurrent cases,64%(37/58)rcurrent cases had identical genotypic patterms,indicating a relapse,36%(21/58)had different genotypes,indicating reinfection by a new strain.Conclusions In Bijing,those people who are 30-59-year old or retreated for pulmonary tuberculosis are more likely to have tuberculosis recurrence.It is indicated that relapse is more common than reinfection in recurrent tuberculosis cases in Beijing,but exogenous reinfection and recent transmission still happen.