An Qiqi, Song Wanmei, Liu Jinyue, Tao Ningning, Liu Yao, Zhang Qianyun, Xu Tingting, Li Shijin, Liu Siqi, Li Yifan, Yu Chunbao, Li Huaichen
Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.
Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, Shandong 100191, People's Republic of China.
Infect Drug Resist. 2020 Nov 13;13:4133-4145. doi: 10.2147/IDR.S277203. eCollection 2020.
With an aging population, China is facing a huge burden of elderly patients with drug resistant tuberculosis (DR-TB), which has become a significant obstacle for the global TB control. There is still little study on DR-TB in the elderly in China so far. Thus, more research on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary.
A retrospective study was conducted in Shandong, China from 2004 to 2019. We collected 12,661 primary TB cases, of which 4368 elderly (≥60 years) primary TB cases were involved. Clinical characteristics including age, sex, cavity, smoking, drinking, comorbidity and drug susceptibility data were collected from 36 TB prevention and control institutions of Shandong Province. Sputum samples were collected by each surveillance site, and examined in the TB Reference Laboratory of SPCH. Descriptive statistical analysis, chi-square and linear regression were used for analyzing.
Among 4368 elderly patients with primary TB, the DR-TB and multi-resistant tuberculosis (MDR-TB) accounted for 17.19% and 2.29%, respectively. During 2004-2019, the proportions of MDR-TB, polydrug resistant tuberculosis (PDR-TB), rifampin (RFP)-resistance increased by 160.00%, 18.18%, 231.82%, respectively and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%. Among the elderly with primary DR-TB during 2004-2019, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP-resistance (from 3.70 to 21.88), and streptomycin (SM)-resistance (from 37.04 to 62.5) increased significantly (P<0.05). And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81), INH-resistance (from 66.67 to 57.81) decreased significantly (P<0.05).
Among the elderly, the proportions of MDR-TB, PDR-TB, RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity, RFP or SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to male, smoking, drinking, chronic obstructive pulmonary disease (COPD) and diabetes subgroups and take targeted measures to control these subgroups.
随着人口老龄化，中国面临着老年耐药结核病（DR-TB）患者的巨大负担，这已成为全球结核病控制的重大障碍。到目前为止，中国对老年人DR-TB的研究仍然很少。因此，有必要对老年人原发性DR-TB的流行病学特征和趋势进行更多研究。
2004年至2019年在中国山东省进行了一项回顾性研究。我们收集了12661例原发性结核病病例，其中包括4368例老年（≥60岁）原发性结核病病例。从山东省36个结核病防治机构收集了年龄、性别、空洞、吸烟、饮酒、合并症和药敏数据等临床特征。每个监测点采集痰标本，并在山东省胸科医院结核病参比实验室进行检测。采用描述性统计分析、卡方检验和线性回归分析。
在4368例老年原发性结核病患者中，DR-TB和耐多药结核病（MDR-TB）分别占17.19%和2.29%。2004年至2019年期间，MDR-TB、广泛耐药结核病（PDR-TB）、利福平（RFP）耐药的比例分别增加了160.00%、18.18%、231.82%，老年原发性空洞型结核病患者的DR-TB率增加了255%。在2004年至2019年期间的老年原发性DR-TB患者中，男性（从85.19%至89.06%）、空洞（从7.41%至46.88%）、RFP耐药（从3.70%至21.88%）和链霉素（SM）耐药（从37.04%至62.5%）的比例显著增加（P<0.05）。而女性（从14.81%至10.94%）、非空洞（从92.59%至32.81%）、异烟肼（INH）耐药（从66.67%至57.81%）的比例显著下降（P<0.05）。
在老年人中，MDR-TB、PDR-TB、RFP耐药和空洞型DR-TB的比例显著增加。DR-TB模式从女性、非空洞和INH耐药组转变为男性、空洞、RFP或SM耐药组。为了未来更好地控制老年DR-TB，我们应更加关注男性、吸烟、饮酒、慢性阻塞性肺疾病（COPD）和糖尿病亚组，并采取针对性措施控制这些亚组。
