中国耐多药结核病（MDR-TB）的疾病负担：一项系统评价与时空分析
Multidrug-resistant tuberculosis (MDR-TB) disease burden in China: a systematic review and spatio-temporal analysis.
作者信息
Ding Peipei, Li Xiaowen, Jia Zhongwei, Lu Zuhong
机构信息
School of Geography, Beijing Normal University, Beijing, 100875, China.
National Institute on Drug Dependence, Peking University Health Science Center, Beijing, 100191, China.
出版信息
BMC Infect Dis. 2017 Jan 10;17(1):57. doi: 10.1186/s12879-016-2151-5.
BACKGROUND
Surveillance data on the proportion of incident TB cases with MDR was limited and there is no systematic study of MDR-TB in China to date. Our aim was to estimate MDR-TB disease burden in 2012 and change trends during 2003-2012 using spatio-temporal systematic analysis.
METHODS
We systematically searched Chinese and English databases for primary articles and reviews that contain MDR-TB survey data about China during the period of 2003-2012. We estimated the proportion of incident TB cases with MDR in cities which had no data to report in 2012 by Kriging spatial interpolation analysis. The primary outcomes were the proportion of incident TB cases with MDR at 2012 and the change trend during 2003-2012.
RESULTS
Total 487 articles met the screening criteria, including 450 in Chinese and 37 in English, and have been used in analysis. The proportion of incident TB cases with MDR among all cases in 2012 showed clear geographic differences. From 2003 to 2012, the proportion of incident TB cases with MDR in all, new and previously treated TB cases were higher during 2006-2009 and significantly lower during 2010-2012 in comparison with the period during 2003-2005 (P < 0.0167). The estimated median proportion of incident TB cases with MDR among all cases, as well as in new and previously treated cases in 2012 was 12.8% (IQR 9.8-17.3%), 5.4% (4.5-7.3%) and 28.5% (20.5-30.9%) respectively, which led to an estimate of 121,600 (IQR93,000-164,350) MDR-TB cases in China.
CONCLUSIONS
This estimate of MDR-TB burden is considerably higher than data reported by the Chinese fifth national tuberculosis epidemiological sampling survey in 2010 but close to the WHO report, which implies that detailed investigations of MDR-TB burden in China is needed. This research provides data to guide public health decisions at various scales; methods described here can be extended to estimate of the other chronic diseases as well.
背景
关于耐多药结核病（MDR）在新发病例中所占比例的监测数据有限，且迄今为止中国尚未对耐多药结核病进行系统研究。我们的目的是通过时空系统分析，估计2012年耐多药结核病的疾病负担以及2003 - 2012年期间的变化趋势。
方法
我们系统检索了中文和英文数据库，查找2003 - 2012年期间包含中国耐多药结核病调查数据的原始文章和综述。通过克里金空间插值分析，我们估计了2012年无数据上报城市中新发结核病病例中耐多药病例的比例。主要结果是2012年新发结核病病例中耐多药病例的比例以及2003 - 2012年期间的变化趋势。
结果
共有487篇文章符合筛选标准，其中中文450篇，英文37篇，并已用于分析。2012年所有病例中耐多药新发结核病病例的比例存在明显的地理差异。2003年至2012年，所有、新发病例和既往治疗病例中耐多药新发结核病病例的比例在2006 - 2009年期间较高，与2003 - 2005年期间相比，在2010 - 2012年期间显著较低（P < 0.0167）。2012年所有病例、新发病例和既往治疗病例中耐多药新发结核病病例的估计中位数比例分别为12.8%（四分位间距9.8 - 17.3%）、5.4%（4.5 - 7.3%）和28.5%（20.5 - 30.9%），据此估计中国有121,600例（四分位间距93,000 - 164,350）耐多药结核病病例。
结论
该耐多药结核病负担估计数远高于中国2010年第五次全国结核病流行病学抽样调查所报告的数据，但与世界卫生组织的报告相近，这意味着需要对中国耐多药结核病负担进行详细调查。本研究提供了数据以指导不同层面的公共卫生决策；此处描述的方法也可扩展用于估计其他慢性病。
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