Chinese Evidence-Based Medicine/Cochrane Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Int J Infect Dis. 2010 Oct;14(10):e828-37. doi: 10.1016/j.ijid.2010.02.2244. Epub 2010 Jun 8.
We aimed to investigate trends in the prevalence of multidrug-resistant tuberculosis (MDR-TB) among Chinese people from first report to 2006, and to detect the high prevalence regions in order to guide control efforts.
The CBM, VIP, CNKI, and MEDLINE databases were searched through both keywords and subject headings. The literature was screened, and two investigators assessed the quality and extracted the data. Trends in MDR-TB prevalence in three groups--primary, acquired, and combined MDR-TB--were examined separately, using the Cochran-Armitage trend test. Differences were tested with the Kruskal-Wallis test. High prevalence provinces were explored through comparison of the 95% confidence interval (95% CI) with the national average level.
Overall 169 studies were included, with 165 in Chinese and four in English. One hundred and sixteen studies concerned primary MDR-TB, 103 acquired MDR-TB, and 130 combined MDR-TB, with total positive Mycobacterium tuberculosis (MTB) isolates of 110 076, 25 187, and 150 233, respectively. The prevalences of MDR-TB in the three groups in 2005 were 2.64-, 6.20-, and 3.84-times that of 1985, respectively, all showing an upward trend (p<0.05). The prevalences among the three groups were significantly different (p<0.05), with acquired drug resistance (27.5%, 95% CI 26.9-28.1%) much higher than primary drug resistance (4.3%, 95% CI 4.2-4.4%), and combined resistance (9.9%, 95% CI 9.8-10.1%) in between. The top three prevalence regions for primary, acquired, and combined MDR-TB were distributed in the zone from the northeast to the southwest of China, with Hebei, Tibet, and Shanxi having an extremely high prevalence.
The prevalence of MDR-TB among the Chinese people has shown an upward trend since 1985. It is necessary to continue to monitor this trend in China. Special attention should be paid to provinces distributed in the zone from the northeast to the southwest of China for MDR-TB surveillance, research, and control.
本研究旨在调查中国人群中从首次报告到 2006 年耐多药结核病（MDR-TB）的流行趋势，并发现高发地区，以指导防控工作。
通过关键词和主题词检索 CBM、VIP、CNKI 和 MEDLINE 数据库。筛选文献，由 2 名研究者评估质量并提取数据。分别采用 Cochran-Armitage 趋势检验和 Kruskal-Wallis 检验分析原发性、获得性和混合性 MDR-TB 三组的 MDR-TB 流行率趋势。通过比较 95%置信区间（95%CI）与全国平均水平，探讨高发省份。
共纳入 169 项研究，其中 165 项为中文，4 项为英文。116 项研究涉及原发性 MDR-TB，103 项涉及获得性 MDR-TB，130 项涉及混合性 MDR-TB，共检测 110076、25187、150233 株结核分枝杆菌阳性培养物。2005 年三组 MDR-TB 的流行率分别为 1985 年的 2.64、6.20 和 3.84 倍，均呈上升趋势（均 P<0.05）。三组间流行率差异有统计学意义（均 P<0.05），获得性耐药（27.5%，95%CI 26.9-28.1%）明显高于原发性耐药（4.3%，95%CI 4.2-4.4%），混合耐药（9.9%，95%CI 9.8-10.1%）居中。原发性、获得性和混合性 MDR-TB 的前三位流行地区分布在中国东北至西南地区，河北省、西藏自治区和山西省的流行率极高。
自 1985 年以来，中国人群中 MDR-TB 的流行呈上升趋势。有必要继续在中国监测这一趋势。对于中国东北至西南地区的 MDR-TB 监测、研究和控制，应特别关注这些省份。
