2007-2020年武汉市耐药肺结核高危人群耐药流行趋势

Analysis of the prevalence trend of drug resistance among high risk population of multi drug resistant-tuberculosis in Wuhan from 2007 to 2020

目的 回顾性分析2007―2020年武汉市耐药肺结核高危人群耐药流行趋势。方法 对2007年1月1日―2020年12月31日武汉市新登记的5 139例耐药肺结核高危人群进行筛查,采用描述性研究、趋势χ^(2)检验和多因素非条件logistic回归分析模型进行统计分析。结果 武汉市耐药肺结核高危人群结核分枝杆菌总耐药率为35.51%(1 600/4 506),6种抗结核药物的任何耐药频度依次为:异烟肼(isoniazid,H)>利福平(rifampin,R)>链霉素(streptomycin,S)>氧氟沙星(ofloxacin,O)>乙胺丁醇(ethambutol,E)>卡那霉素(Kanamycin,K)。2007―2020年除O耐药率外,总耐药率、耐多药率和H、R、S、E、K耐药率均呈上升趋势(R耐药率:P=0.002,其余均有P<0.001)。2015―2020年耐药、耐多药、H、E、S、O、K耐药率均无上升趋势,R耐药率呈上升趋势(P=0.002)。结论 2007―2020年武汉市耐药肺结核高危人群耐药疫情呈上升趋势。虽然2015―2020年未呈上升趋势,但仍迫切需要加强对此类人群的管理和控制。

Objective To retrospectively analyze the drug resistance prevalence trend of drug resistance-tuberculosis(DR-TB) high-risk populations in Wuhan from 2007 to 2020.Methods From January 1,2007 to December 31,2020,a total of 5 139 at risk individuals of DR-TB newly registered in Wuhan were screened.By carrying out a descriptive study,χ^(2) test and multivariate unconditional logistic regression,the prevalence trend and influencing factors of drug resistance were analyzed.Results The overall drug resistance rate among these individuals was 35.51%(1 600/4 506).The ranking of resistance rates of six different anti-TB drugs was as following,Isoniazid(H)>Rifampin(R)>Streptomycin(S)>Ofloxacin(O)>ethambutol(E)>Kanamycin(K).From 2007 to 2020,except the O resistance rate,the overall drug resistance rate,multidrug resistance rate,drug resistance rates of H,R,E,S and K showed an upward trend( R resistance rate:P=0.002,all the others have P<0.001).From 2015 to 2020,except an upward trend was observed in R resistance rate(P=0.002),the overall drug resistance rate,multidrug resistance rate and drug resistance rates of H,E,S,O and K remained stable.Conclusions From 2007 to 2020,an upward trend of drug resistance among Wuhan’s DR-TB at risk populations was observed.Although no upward trend was observed in the period between 2015 and 2020,further strengthening of management and control of such groups is still urgently needed.