中国山东省农村地区耐药结核病的流行趋势及特征

Trends and characteristics of drug-resistant tuberculosis in rural Shandong, China.

作者信息

Tao Ning-Ning, He Xiao-Chun, Zhang Xian-Xin, Liu Yao, Yu Chun-Bao, Li Huai-Chen

机构信息

Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.

Department of Respiratory Medicine, Baoji Central Hospital, Baoji, Shaanxi, China.

出版信息

Int J Infect Dis. 2017 Dec;65:8-14. doi: 10.1016/j.ijid.2017.09.019. Epub 2017 Sep 25.

DOI:10.1016/j.ijid.2017.09.019

PMID:28958922

Abstract

OBJECTIVES

The aim of this study was to describe the secular trends in drug-resistant tuberculosis (DR-TB) and to identify unique characteristics of multidrug-resistant tuberculosis (MDR-TB) in rural China.

METHODS

A retrospective study was conducted using TB data collected from 36 TB prevention and control institutions serving rural populations in Shandong Province, China, for the period 2006-2015.

RESULTS

Approximately 8.3% of patients suffered from MDR-TB, among whom 70% were newly treated patients; this rate increased by 1.3% annually during the 10-year study period. An increase in the percentage of overall first-line drug resistance against isoniazid, rifampicin, ethambutol, and streptomycin was confirmed (p<0.05). The percentage of MDR-TB in new and previously treated cases increased at yearly rates of 9.9% and 11.1%, respectively. MDR-TB patients were more likely to be female (odds ratio (OR) 1.58, 95% confidence interval (CI) 1.32-1.89), smokers (OR 1.75, 95% CI 1.47-2.07), to have had recent TB contact (OR 1.58, 95% CI 1.04-2.42), or to have been retreated (OR 2.89, 95% CI 2.46-3.41).

CONCLUSIONS

Increasing MDR-TB and rates of primary MDR-TB characterize DR-TB cases in rural China. Persistent efforts need to be made among MDR-TB patients in future TB control strategies.

摘要

目的

本研究旨在描述耐药结核病（DR-TB）的长期趋势，并确定中国农村地区耐多药结核病（MDR-TB）的独特特征。

方法

采用回顾性研究方法，利用2006 - 2015年期间从中国山东省36个为农村人口服务的结核病防治机构收集的结核病数据。

结果

约8.3%的患者患有耐多药结核病，其中70%为新治疗患者；在为期10年的研究期间，该比例每年上升1.3%。已证实对异烟肼、利福平、乙胺丁醇和链霉素的一线药物总体耐药率有所上升（p<0.05）。新发病例和既往治疗病例中耐多药结核病的比例分别以每年9.9%和11.1%的速度增长。耐多药结核病患者更可能为女性（优势比（OR）1.58，95%置信区间（CI）1.32 - 1.89）、吸烟者（OR 1.75，95% CI 1.47 - 2.07）、近期有结核病接触史（OR 1.58，95% CI 1.04 - 2.42）或曾接受过再治疗（OR 2.89，95% CI 2.46 - 3.41）。