Ma Jun, Liu Hongcheng, Wang Jingjing, Li Wenting, Fan Lin, Sun Wenwen
Department of Tuberculosis and Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Infect Drug Resist. 2022 Mar 19;15:1155-1165. doi: 10.2147/IDR.S342744. eCollection 2022.
China is the region with a high global burden of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the clinical and demographic characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) from 2015 to 2019 to provide evidence for the prevention and control of the disease in high TB burden areas.
We investigated the clinical and demographic data of all MDR/RR-EPTB cases in a TB specialized hospital from China and compared the cases with the MDR/RR-pulmonary tuberculosis (PTB) patients over the same period.
Of the RR/MDR-TB patients enrolled, 15.4 were EPTB. The most common anatomical site was pleural/chest wall (25.9%). Compared with RR/MDR-PTB, females were more likely to be susceptible to RR/MDR-EPTB (OR 1.65, 95% CI 1.52-1.77); the risk of RR/MDR-EPTB for 25-44 years group increased (OR 1.61, 95% CI 1.52-1.77), and then decreased with the increasing age (OR 1.48, 95% CI 0.74-1.69 for 44-65 years group and OR 2.23, 95% CI 0.98-2.71 for ≥65 years group); more likely to be newly diagnosed ( < 0.01) and less likely to to combine with diabetes (P < 0.01), more dependent on GeneXpert MTB/RIF (Xpert, 90.9%) for diagnosis, with significantly higher rates of pre-XDR/XDR and significantly lower favorable treatment outcomes (both p < 0.01).
There are clinical and demographic differences between RR/MDR-PTB and RR/MDR-PTB. Xper should be recommended at an early stage for suspected patients, and fluoroquinolones should be used cautiously for anti-infective therapy in this population.
中国是全球耐利福平/耐多药结核病（RR/MDR-TB）负担高且艾滋病毒发病率低的地区。我们的目的是评估2015年至2019年RR/MDR肺外结核病（EPTB）的临床和人口统计学特征，为高结核病负担地区的疾病预防和控制提供证据。
我们调查了中国一家结核病专科医院所有耐多药/利福平耐药EPTB病例的临床和人口统计学数据，并将这些病例与同期的耐多药/利福平耐药肺结核（PTB）患者进行比较。
在纳入的RR/MDR-TB患者中，15.4%为EPTB。最常见的解剖部位是胸膜/胸壁（25.9%）。与RR/MDR-PTB相比，女性更易患RR/MDR-EPTB（比值比1.65，95%置信区间1.52-1.77）；25-44岁组患RR/MDR-EPTB的风险增加（比值比1.61，95%置信区间1.52-1.77），然后随着年龄增长而降低（44-65岁组比值比1.48，95%置信区间0.74-1.69，≥65岁组比值比2.23，95%置信区间0.98-2.71）；更易为新诊断病例（P<0.01），合并糖尿病的可能性较小（P<0.01），更依赖GeneXpert MTB/RIF（Xpert，90.9%）进行诊断，广泛耐药/耐多药前的发生率显著更高，良好治疗结局的发生率显著更低（均P<0.01）。
RR/MDR-EPTB与RR/MDR-PTB之间存在临床和人口统计学差异。对于疑似患者，应早期推荐使用Xpert，该人群抗感染治疗应谨慎使用氟喹诺酮类药物。
