Han Z Y, Li J, Gu K K, Sun G M, Jiang Y, Zhang Y Y, Xu B
Department of Chronic Infectious Diseases, Jing'an District Center for Disease Control and Prevention, Shanghai 200072, China.
Tuberculosis Laboratory, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Oct 10;39(10):1339-1345. doi: 10.3760/cma.j.issn.0254-6450.2018.10.010.
To understand the recent transmission of (MTB), and to identify the influencing factors of recent transmission among pulmonary tuberculosis (TB) patients in Jing'an district, Shanghai. The genotypes and drug resistances of MTB isolated from TB patients registered in the TB designated hospitals in Jing'an district during 2010-2015 were analyzed through 12-loci Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR)(QUB11b, QUB18, Mtub21, Miru26, QUB26, Mtub04, Miru31, Miru40, VNTR2372, VNTR3820, 3232, 4120), and tested for drug susceptibility as well. With the results of field epidemiological investigation, univariate and multivariate analyses were performed to analyze the distribution of the clusters and influencing factors on recent transmission. This study enrolled 80 TB patients, 23 (28.75%) had a resistance to at least one anti-TB drug, and the prevalence of multidrug-resistant tuberculosis (MDR-TB) was 16.25%. A total of 65 genotypes were identified with 58 (72.50%, 58/80) being unique and 7 clusters with 2-10 isolated in each cluster. The proportion of clustering was 27.50% (22/80). Results from the multivariate analysis revealed that multidrug- resistance (=35.799, 95: 4.239-302.346) and having comorbidity with TB (=7.695, 95: 1.421-41.658) were independently associated with the clustering, which suggesting a recent transmission. The field investigation to the clustered cases proved that the patients in two clusters had epidemiological links, one was between family members, and the other contained 10 MDR-TB patients with 9 knowing each other which have a definite connection and 1 having the possible connection with them. Recent transmission of tuberculosis happened among TB patients in Jing'an district, with high risks among the MDR-TB patients.
为了解结核分枝杆菌（MTB）的近期传播情况，并确定上海市静安区肺结核（TB）患者近期传播的影响因素。通过12个位点的分枝杆菌插入重复单位可变数目串联重复序列（MIRU-VNTR）（QUB11b、QUB18、Mtub21、Miru26、QUB26、Mtub04、Miru31、Miru40、VNTR2372、VNTR3820、3232、4120）分析了2010 - 2015年期间静安区结核病定点医院登记的TB患者分离出的MTB的基因型和耐药性，并进行了药敏试验。结合现场流行病学调查结果，进行单因素和多因素分析，以分析聚类分布及近期传播的影响因素。本研究纳入80例TB患者，23例（28.75%）对至少一种抗结核药物耐药，耐多药结核病（MDR-TB）患病率为16.25%。共鉴定出65种基因型，其中58种（72.50%，58/80）为独特基因型，7个聚类，每个聚类中有2 - 10株分离株。聚类比例为27.50%（22/80）。多因素分析结果显示，耐多药（=35.799，95%可信区间：4.239 - 302.346）和合并TB（=7.695，95%可信区间：1.421 - 41.658）与聚类独立相关，提示近期传播。对聚类病例的现场调查证明，两个聚类中的患者存在流行病学联系，一个是家庭成员之间，另一个聚类中有10例MDR-TB患者，其中9例相互认识，有明确联系，1例与他们可能有联系。静安区TB患者中发生了结核病的近期传播，MDR-TB患者中传播风险较高。
