School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, No.9 Beijing Road, Yunyan District, Guiyang city, 550025, Guizhou Province, China.
Guizhou Center for Disease Control and Prevention, No.73, Bageyan Road, Yunyan District, Guiyang city, 550004, Guizhou Province, China.
BMC Infect Dis. 2024 Sep 27;24(1):1058. doi: 10.1186/s12879-024-09976-9.
Rifampicin-resistant pulmonary tuberculosis (RR-PTB) presents a significant threat to global public health security. China bears a substantial burden of RR-PTB cases globally, with Guizhou Province experiencing particularly alarming trends, marked by a continual increase in patient numbers. Understanding the population characteristics and treatment modalities for RR-PTB is crucial for mitigating morbidity and mortality associated with this disease.
We gathered epidemiological, diagnostic, and treatment data of all RR-PTB cases recorded in Guizhou Province from January 1, 2017 to December 31, 2023. Utilizing composition ratios as the analytical metric, we employed Chi-square tests to examine the spatiotemporal distribution patterns of RR-PTB patients and the evolving trends among different patient classifications over the study period.
In our study, 3396 cases of RR-PTB were analyzed, with an average age of 45 years. The number of RR-PTB patients rose significantly from 176 in 2017 to 960 in 2023, peaking notably among individuals aged 23-28 and 44-54, with a rising proportion in the 51-80 age group (P < 0.001). Since 2021, there has been a notable increase in the proportion of female patients. While individuals of Han ethnic group comprised the largest group, their proportion decreased over time (P < 0.001). Conversely, the Miao ethnicity showed an increasing trend (P < 0.05). The majority of patients were farmers, with their proportion showing an upward trajectory (P < 0.001), while students represented 4.33% of the cases. Geographically, most patients were registered in Guiyang and Zunyi, with a declining trend (P < 0.001), yet household addresses primarily clustered in Bijie, Tongren, and Zunyi. The proportion of floating population patients gradually decreased, alongside an increase in newly treated patients and those without prior anti-tuberculosis therapy. Additionally, there was a notable rise in molecular biological diagnostic drug sensitivity (real-time PCR and melting curve analysis) (P < 0.001). However, the cure rate declined, coupled with an increasing proportion of RR-PTB patients lost to follow-up and untreated (P < 0.05).
Enhanced surveillance is crucial for detecting tuberculosis patients aged 23-28 and 44-54 years. The distribution of cases varies among nationalities and occupations, potentially influenced by cultural and environmental factors. Regional patterns in RR-PTB incidence suggest tailored prevention and control strategies are necessary. Despite molecular tests advances, challenges persist with low cure rates and high loss to follow-up. Strengthening long-term management, resource allocation, and social support systems for RR-PTB patients is essential.
利福平耐药性肺结核（RR-PTB）对全球公共卫生安全构成重大威胁。中国在全球 RR-PTB 病例中负担沉重，贵州省的情况尤为令人担忧，患者数量持续增加。了解 RR-PTB 的人群特征和治疗方式对于减轻与该疾病相关的发病率和死亡率至关重要。
我们收集了 2017 年 1 月 1 日至 2023 年 12 月 31 日期间贵州省所有 RR-PTB 病例的流行病学、诊断和治疗数据。我们使用构成比作为分析指标，采用卡方检验分析 RR-PTB 患者的时空分布模式以及研究期间不同患者分类的变化趋势。
本研究共分析了 3396 例 RR-PTB 患者，平均年龄为 45 岁。RR-PTB 患者数量从 2017 年的 176 例显著增加到 2023 年的 960 例，23-28 岁和 44-54 岁人群中明显增加，51-80 岁人群的比例呈上升趋势（P<0.001）。自 2021 年以来，女性患者的比例显著增加。汉族是最大的群体，但随着时间的推移，其比例逐渐下降（P<0.001）。相反，苗族的比例呈上升趋势（P<0.05）。大多数患者是农民，其比例呈上升趋势（P<0.001），而学生占病例的 4.33%。从地域上看，大多数患者在贵阳和遵义登记，呈下降趋势（P<0.001），但家庭住址主要集中在毕节、铜仁和遵义。流动人口患者的比例逐渐减少，同时新治疗患者和未经抗结核治疗的患者比例增加。此外，分子生物学诊断药物敏感性（实时 PCR 和熔解曲线分析）的比例显著增加（P<0.001）。然而，治愈率下降，同时 RR-PTB 患者失访和未治疗的比例增加（P<0.05）。
加强监测对于发现 23-28 岁和 44-54 岁的结核病患者至关重要。病例的分布在民族和职业之间存在差异，这可能受到文化和环境因素的影响。RR-PTB 发病率的地区模式表明需要制定有针对性的预防和控制策略。尽管分子检测取得了进展，但低治愈率和高失访率仍然存在挑战。加强 RR-PTB 患者的长期管理、资源配置和社会支持系统至关重要。
