2013—2018年江苏省结核分枝杆菌耐药性特征及趋势分析

Analysis of drug-resistance characteristics and trend of Mycobacterium tuberculosis in Jiangsu Province from 2013 to 2018

目的了解江苏省结核病耐药特征及变化趋势,为耐药结核病的防控提供科学依据。方法回顾分析江苏省4个结核病耐药性监测点数据,连续纳入2013—2018年经抗酸染色镜检发现的涂片阳性肺结核患者。采用比例法药敏检测技术,对7种抗结核药物进行药敏检测分析。结果2013—2018年,纳入1064例病例,初治占89.66%,复治占10.34%。81.11%的病例对所有抗结核一线药物(包括利福平、异烟肼、链霉素和乙胺丁醇)均敏感,发生任一耐药占22.00%,单一耐药占10.43%;耐多药占4.70%,其中广泛耐药前期占46.00%,广泛耐药1例。链霉素耐药率最高(11.94%),其次为异烟肼(11.56%)、利福平(6.39%)、氧氟沙星(4.61%)、卷曲霉素(1.60%)、乙胺丁醇(1.60%)、卡那霉素(1.32%),不同药物耐药率有统计学差异(χ^(2)=258.18,P<0.05)。耐利福平、耐异烟肼、耐多药、单一耐药及任一耐药情况各年耐药率差异均无统计学意义(P值均>0.05)。经性别、年龄标化后,复治患者中耐利福平风险为初治患者的5.27倍(95%CI:2.94~9.44),耐异烟肼风险为2.31倍(95%CI:1.38~3.86),耐氧氟沙星风险为2.84倍(95%CI:1.38~5.84),耐多药患者风险为6.02倍(95%CI:3.14~11.55),广泛耐药前期风险为3.60倍(95%CI:1.35~9.60),任一耐药风险为1.74倍(95%CI:1.12~2.70)(P值均<0.05)。结论 2013—2018年江苏省耐药率无下降趋势,链霉素耐药问题依然突出,复治患者耐药风险明显增高。

Objective To describe the characteristics and trend of drug-resistant tuberculosis(DR-TB) in Jiangsu Province;to provide evidence to making DR-TB control strategies. Methods This prospective study was conducted in 4 DR-TB surveillance spots in Jiangsu Province, and pulmonary TB patients with sputum smear-positive assay were included from 2013 to 2018.Drug susceptibility test was performed on 7 major anti-TB drugs by proportional method drug sensitivity detection technology. Results A total of 1 064 patients were included for the study, 89.66% were new TB cases and 10.34% were previously treated TB cases.The 81.11% patients were susceptible to all first-line anti-TB drugs(including rifampicin, isoniazid, streptomycin and ethambutol),and 22.00% were resistant to at least 1 drug.The monodrug resistance rate was 10.43%,the multidrug-resistant(MDR) rate was 4.70%,among which the early stage of extensive drug resistance accounted for 46.00% and 1 extensive drug resistant patient was identified.Streptomycin had the highest drug-resistant rate(11.94%),followed by isoniazid(11.56%),rifampicin(6.39%),ofloxacin(4.61%),capreomycin(1.60%),ethambutol(1.60%) and kanamycin(1.32%),the difference was statistically significant(χ^(2)=258.18,P<0.05).Meanwhile, the difference among drug-resistant rates for rifampicin, isoniazid, MDR,monodrug and any of those drugs were not significant from 2013 to 2018(all P>0.05). Compared to new TB cases, after adjusted by age and gender, TB treatment history increased the risk of rifampicin resistance by 5.27 folds(95%CI:2.94-9.44),2.31 folds(95%CI:1.38-3.86) for isoniazid resistance, 2.84 folds(95%CI:1.38-5.84) for ofloxacin resistance, 6.02 folds(95% CI:3.14-11.55) for MDR, 3.60 folds(95% CI:1.35-9.60) for pre-XDR and 1.74 folds(P=0.014,95% CI:1.12-2.70) for any drug resistance(all P<0.05). Conclusion The TB drug resistance rate in Jiangsu Province from 2013 to 2018 did not show significant descending trend from 2013 to 2018.The streptomycin resistant rate was at high level and previous TB treatment history was the major risk factor for TB drug resistance.