福建省肺结核患者利福平耐药趋势与影响因素

Trends and influencing factors of rifampicin resistance in pulmonary tuberculosis patients in Fujian Province

目的分析福建省肺结核患者利福平(RFP)耐药率、变化趋势及影响因素,为制定本省耐药结核病防控方案提供依据。方法用横断面研究法分析福建省2018—2022年登记的22731例病原学阳性肺结核患者耐药筛查结果,探讨利福平耐药的影响因素。结果福建省2018—2022年肺结核患者利福平总耐药率为5.0%(1140/22731),各年耐药率及初治、复治患者的耐药率均总体上下降(趋势χ^(2)值=155.28、79.00、6.58,P<0.05);多因素logistic回归分析显示,45~59岁组和≥60岁组耐药风险较低(OR=0.79和0.58);与学生/儿童比较,其余各职业组耐药风险均较大(OR值均>2.4);外地户籍(OR=1.71)、复治患者耐药风险均较大(OR=5.42);福建省闽南和闽西北地区耐药风险较低(OR值=0.69、0.81)。结论福建省肺结核患者利福平耐药率较低,总体呈下降趋势,耐药防控工作取得一定成效;仍需进一步加强耐药筛查工作,尽可能对耐药肺结核患者开展规范治疗,以降低利福平耐药肺结核的患病率水平。

Objective To analyze the rifampicin(RFP)resistance rate,trend,and influencing factors among pulmonary tuberculosis patients in Fujian Province,and to provide a basis for the development of a provincial drug-resistant tuberculosis control plan.Methods A cross-sectional study was conducted to analyze the drug resistance test results of 22731 bacteriologically confirmed pulmonary tuberculosis patients registered in Fujian Province from 2018 to 2022.Influencing factors of rifampicin resistance was explored.Results The overall rifampicin resistance rate among pulmonary tuberculosis patients in Fujian Province from 2018 to 2022 was 5.0%(1140/22731).The resistance rates in each year,as well as among new and retreated patients,showed a decreasing trend(χ^(2)trend=155.28,79.00,6.58,all P<0.05).Multivariate logistic regression analysis revealed that the risk of rifampicin resistance was lower in the 45-59 year-old group and the≥60 year-old group(OR=0.79 and 0.58,respectively).Compared to students/children,the risk of rifampicin resistance was higher in other occupations(all OR>2.4).The risk of rifampicin resistance was higher in patients from other provinces(OR=1.71)and retreated patients(OR=5.42).However,the risk of rifampicin resistance was lower in the southern and northwestern regions of Fujian Province(OR=0.69 and 0.81,respectively).Conclusion The rifampicin resistance rate among pulmonary tuberculosis patients in Fujian Province was relatively low and had shown a decreasing trend,indicating that the drug resistance control efforts have achieved some success.However,further strengthening of drug resistance testing and standardized treatment of drug-resistant tuberculosis patients are still necessary to reduce the incidence of rifampicin-resistant tuberculosis.