延安地区结核病患者结核分枝杆菌的成簇特征及传播危险因素

Clustering Characteristics and Transmission Risk Factors of Mycobacterium Tuberculosis in Tuberculosis Patients in the Yan'an Area

【目的】探讨延安地区结核病患者结核分枝杆菌(MTB)的成簇特征并分析其传播危险因素。【方法】选取2018年10月至2020年10月在延安地区各医院结核病门诊收集的224株MTB进行研究,对其进行基因鉴定后分析其成簇特征,将86例MTB成簇患者纳入成簇组,将138例未成簇患者纳入唯一组(n=138),比较两组一般资料和治疗情况,将两组有差异信息的项目纳入Logistic回归分析模型,进行量化赋值明确结核病患者MTB成簇的危险因素。【结果】本研究224株MTB中有86例菌株形成36个簇,成簇率为38.39%,最大簇为6株成簇,占比为6.98%,近期传播率为22.32%。成簇组中年龄≥60岁、流动户籍、北京基因型菌株、既往未行卡介苗(BCG)治疗、耐药、合并糖尿病患者比例显著高于唯一组,且差异有统计学意义(P<0.05)。经Logistic回归性分析证实上述因素均是引起结核病患者MTB成簇的危险因素。【结论】延安地区结核病患者MTB成簇率为38.39%,最大簇为6株成簇,而高龄、流动户籍、北京基因型菌株、既往未行BCG治疗、耐药、合并糖尿病等人口学特征均为促进结核病传播的危险因素。

【Objective】To explore the clustering characteristics of Mycobacterium tuberculosis(MTB)in tuberculosis patients in the Yan'an area and analyze its transmission risk factors.【Methods】A total of 224 MTB strains collected from tuberculosis clinics of hospitals in Yan'an area from October 2018 to October 2020 were selected for study,and their clustering characteristics were analyzed after genetic identification.86 patients with MTB clustering were included in the clustering group,and 138 patients without MTB clustering were included in the single group(n=138).The general data and treatment of the two groups were compared,and the items with different information between the two groups were included in the logistic regression analysis model,Quantitative assignment was performed to identify the risk factors for MTB clustering in patients with tuberculosis.【Results】Among the 224 MTB strains in this study,86 strains formed 36 clusters,the clustering rate was 38.39%,the largest cluster was 6 strains,accounting for 6.98%,and the recent transmission rate was 22.32%.In the cluster group,the proportion of patients with age≥60 years old,mobile registered residence,Beijing genotype strains,no previous BCG treatment,drug resistance,and diabetes was significantly higher than that of the single group,and the difference was statistically significant(P<0.05).Logistic regression analysis confirmed that the above factors were the risk factors of MTB clustering in patients with tuberculosis.【Conclusion】The MTB clustering rate of tuberculosis patients in the Yan'an area is 38.39%,and the largest cluster is 6 strains.Demographic characteristics such as old age,mobile registered residence,Beijing genotype strains,previous failure to receive BCG treatment,drug resistance,and diabetes are risk factors to promote the spread of tuberculosis.