贵州省耐药肺结核人群特征及诊疗情况分析

Analysis on the characteristics and diagnosis and treatment of tuberculosis patients with drug resistance in Guizhou Province

目的了解贵州省耐药肺结核(DR-TB)人群分布特征及其诊疗情况,为贵州省DR-TB防治提供参考。方法数据来源于中国疾病预防控制信息系统肺结核信息管理系统登记的2013—2018年贵州省DR-TB患者病案信息,采用描述性流行病学方法分析DR-TB的分布特征,采用SPSS 17.0软件进行趋势χ^(2)检验,Fisher精确检验。结果贵州省DRTB患者从2013年的39例上升至2018年的225例,共计966例,其中男性671例、女性295例,性别比为2.27∶1,21~40岁年龄段患者最多(405例,41.93%),其构成比呈下降趋势(趋势χ^(2)=6.126,P<0.05)。职业为农民的患者最多(482例,49.90%),学生患者构成比呈上升趋势(趋势χ^(2)=7.052,P<0.01)。毕节地区DR-TB患者最多(226例,23.40%)。登记为初治失败的患者最多(464例,48.03%),新患者构成比呈上升趋势(趋势χ^(2)=30.543,P<0.01)。耐药检测中,分子核酸检测占60.15%,其构成比呈上升趋势(趋势χ^(2)=111.547,P<0.01)。97例(10.04%)患者在进行耐药结核治疗前使用过二线抗结核药品。耐药患者中以耐多药(MDR-TB)患者最多(847例,87.68%),其次为利福平耐药(RR-TB)。2013—2016年完成两年疗程疗效判定为治愈和完成治疗分别有186例和94例,每年的在治患者呈下降趋势(趋势χ^(2)=8.797,P<0.01)。MDR-TB及RR-TB的成功治疗率为54.25%,成功治疗率呈上升趋势(趋势χ^(2)=8.573,P<0.01)。结论贵州省DR-TB患者数量呈上升趋势,以MDR-TB为主,需加强肺结核耐药监测,特别是初治患者原发性耐药的监测,建议通过提高患者医疗费用的报销比例,以提高耐药患者的纳入治疗率和成功治疗率。

Objective To understand the distribution characteristics and diagnosis and treatment of DR-TB in Guizhou Province,to provide reference for the prevention and treatment of people with DR-TB in Guizhou Province.Methods The data were from the medical records of DR-TB patients in Guizhou Province from 2013 to 2018 registered by the TB Information Management System of China Disease Prevention and Control Information System,the distribution characteristics of DR-TB were analyzed by descriptive epidemiological method,the trendχ^(2)test,the Fisher exact test method were used.The used software was SPSS 17.0.Results The number of DR-TB cases in Guizhou Province increased from 39 cases in 2013 to 225 cases in 2018,a total of DR-TB cases were 966 cases(male:671 cases,female:295 cases;sex ratio=2.27∶1),the number of DR-TB cases in 21-40 years old group was the greatest(405 cases,41.93%),and the composition ratio showed a significant decreasing trend(trendχ^(2)=6.126,P<0.05).The most patients were farmers(482 cases,49.90%),and the student patient ratio showed a significant increasing trend(trendχ^(2)=7.052,P<0.01).The number of DR-TB cases in Bijie district was the most(226 cases,23.40%).The largest number of patients registered were DR-TB cases with initial treatment failure(464 cases,48.03%),and the composition ratio of new patients showed a significant upward trend(trendχ^(2)=30.543,P<0.01).In the detection of drug resistance,the proportion of molecular nucleic acid testing(NAT)was 60.15%,and the composition ratio showed a significant increasing trend(trendχ^(2)=111.547,P<0.01).The proportion of patients with second-line anti-TB drugs before receiving DR-TB treatment was 10.04%(97 cases).The proportion of DR-TB patients with MDR-TB was the most(847 cases,87.68%),followed by rifampicin resistance(RR-TB).From 2013 to 2016,there were 186 cases diagnosed as cure and 94 cases diagnosed as completion of the two-year treatment course,there was a significant decreasing trend of cured patients each year(trendχ^(2)=8.797,P<0.01).and the successful treatment rate of MDR-TB and RR-TB patients was 54.25%,showing a significant increase(trendχ^(2)=8.573,P<0.01).Conclusion The number of DR-TB patients in Guizhou Province show an increasing trend(main MDR-TB),so it is necessary to strengthen the monitoring of tuberculosis resistance,especially the monitoring of primary drug resistance of patients initially treated.It is suggested to improve the inclusion and successful treatment rate of drug-resistant patients by increasing the reimbursement rate of patients’medical expenses.