青海省利福平耐药/耐多药肺结核流行特征分析

Epidemiological characteristics of rifampicin-resistant and multidrug-resistant tuberculosis in Qinghai

目的掌握青海省利福平耐药结核病检出情况和耐多药结核病分布情况,为利福平耐药结核病防控提供理论依据。方法收集青海省2016—2019年最终鉴定为结核分枝杆菌的1182株菌株,采用比例法对4种一线及2种二线常用抗结核药品(异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星)进行药物敏感性试验,并对上述菌株的利福平耐药性检测结果及耐多药结核病进行统计学分析。结果1182株菌总利福平耐药率为11.42%,总耐多药率为8.80%。总耐多药结核病患者占利福平耐药结核病患者的77.04%。不同年份利福平耐药率、耐多药率差异有统计学意义(χ^(2)=373.672、225.453,P<0.05),复治患者利福平耐药率、耐多药率高于初治患者,差异均有统计学意义(χ^(2)=130.865、99.943,P<0.05);不同性别(χ^(2)=130.779、99.888,P<0.05)、年龄(χ^(2)=342.791、163.139,P<0.05)、民族(χ^(2)=130.993、100.003,P<0.05)和职业(χ^(2)=253.844、186.207,P<0.05)的利福平耐药率、耐多药率比较差异均有统计学意义。结论青海省利福平耐药率较高,并且主要为耐多药,应加强对男性、中青年、少数民族、农牧民等重点人群的耐药性监测与治疗。

Objective To understand the detection of rifampicin-resistant tuberculosis(RR-TB)and the distribution of multidrug-resistant tuberculosis(MDR-TB)in Qinghai province and provide theoretical evidence for the prevention and control of RR-TB.Methods The tuberculosis reference laboratory of Qinghai Provincial Center for Disease Control and Prevention used the proportional method to test the drug susceptibility of 1182 Mycobacterium tuberculosis strains collected from 8 cities in Qinghai from 2016 to 2019 to four commonly used first-line and two second-line anti-TB drugs(isoniazid,rifampicin,ethambutol,streptomycin,kanamycin,ofloxacin).The results of rifampicin-resistance detection and MDR-TB prevalence were analyzed.Results The overall rifampicin-resistant rate of 1182 M.tuberculosis strains was 11.42%,and the overall multidrug-resistant rate was 8.80%.The MDR-TB cases accounted for 77.04%of RR-TB cases.The differences in rifampicin-resistant rate and multidrug-resistant rate in different years were significant(χ^(2)=373.672,225.453,P<0.05).The rifampicin-resistant rate and multidrug-resistant rate were higher in retreated cases than in initial treated cases,and the difference was significant(χ^(2)=130.865,99.943,P<0.05).There were statistically significant differences in rifampicin-resistant and multidrug-resistant rate between men and women(χ^(2)=130.779,99.888,P<0.05),among different age groups(χ^(2)=342.791,163.139,P<0.05),ethnic groups(χ^(2)=130.993,100.003,P<0.05)and occupation groups(χ^(2)=253.844,186.207,P<0.05).Conclusion The rifampicin-resistant rate in TB cases in Qinghai was high,and multi-drug resistance was also common.Therefore,the surveillance and treatment of drug–resistant TB should be strengthened,especially in men,young and middle-aged people,ethnic minorities,farmers and herdsmen and other key groups.