“十三五”期间贵州省利福平耐药结核病发现情况分析

Detection of rifampicin-resistant tuberculosis in Guizhou during the 13th Five-Year Plan period

目的 通过分析2016—2020年“十三五”结核病防治规划实施期间贵州省利福平耐药结核病(rifampicin-resistant tuberculosis,RR-TB)患者的发现情况,探讨影响贵州省RR-TB患者发现的主要原因,为进一步完善贵州省耐药结核病防控政策提供参考依据。方法 收集中国结核信息管理系统中2016—2020年贵州省肺结核患者耐药筛查数据,分析不同年份的RR-TB患者的估算数和实际发现数、药敏诊断时间和检测方法、病原学诊断结果。采用Kruskal-Wallis检验比较各年间耐药诊断时间的差异。结果 2016—2020年共发现RR-TB患者3 588例,RR-TB患者发现数和发现率从2016年的280例和7.65%增至2020年的1 038例和32.05%,这与病原学阳性率和耐药筛查率从2016年的30.19%和12.01%上升到2020年的56.82%和67.59%密切相关,但贵州省9个市(州)病原学阳性率和耐药筛查率差异仍较大。另外,RR-TB患者开展氟喹诺酮(fuoroquinolones,FQs)药敏检测比例较低,从2016年起逐年下降至2020年的8.07%。而随着分子生物学快速药敏使用比例的上升,耐药诊断时间间隔也从2016年的103 d缩短至2020年的33 d。结论 随着政府承诺和结核病防控规划的出台及贵州省耐药结核病综合防控措施的实施,使RR-TB发现水平明显提升,但还存在RR-TB发现率较低、耐药诊断时间较长、RR-TB患者开展FQs药敏比例较低等问题。应切实加强各级结核病防治机构实验室能力、人员素质及卫生资源的合理配置,以提高RR-TB患者发现率,有效遏制耐药结核的流行。

Objective To analyze the detection of the rifampicin-resistant tuberculosis(TB) in Guizhou province during the 13th Five-Year Plan period(2016-2020), identify the main factors affecting the detection of rifampicin-resistant TB in Guizhou, and provide reference and evidence for the development of more precise national drug resistant TB prevention and control policy. Methods The data related to rifampicin resistance screening in Guizhou were collected from 2016 to 2020from the National Tuberculosis Information Management System(TBIMS), and descriptive research method was used to analyze the estimated and actual incidence of rifampicin-resistant TB, drug resistance testing time and methods and etiological diagnosis results in each year. Kruskal-Wallis test was used to compare the differences in median days needed for the detection of rifampicin-resistant TB in each year. Results A total of 3 588 rifampicin-resistant TB cases were detected in Guizhou during 2016-2020. The number and detection rate of rifampicin-resistant TB cases increased from 280 cases and 7.65% in2016 to 1 038 cases and 32.05% in 2020, which was closely related to the increase of etiological positive rate and drug resistance screening rate from 30.19% and 12.01% in 2016 to 56.82% and 67.59% in 2020, but there were significant differences in etiological positive rate and drug resistance screening rate among 9 area in Guizhou. In addition, in 2020,fuoroquinolone(FQ) susceptibility testing was performed for only 8.07% of rifampicin-resistant TB cases, and this proportion has been declining year by year since 2016. As the use of molecular rapid drug sensitivity test increased, the time interval for drug resistance diagnosis was significantly shortened from 103 days in 2016 to 33 days in 2020. Conclusion With the government’s commitment and the introduction of TB prevention and control plan, as well as the implementation of comprehensive drug-resistant TB prevention and control measures in Guizhou, the detection level of rifampicin-resistant TB has been significantly improved, but there are still problems, such as low detection rate of rifampicin-resistant TB, long interval of drug-resistant TB diagnosis, and low proportion of FQ susceptibility testing rate in rifampicin-resistant TB patients.Therefore, it is necessary to strengthen laboratory capacity, staff capability and rational allocation of health resources in TB prevention and control institutions at all levels to stop the spread of drug-resistant TB.