Wu Lianpeng, Cai Xiyue, Xu Shuya, Lin Xuefeng, Peng Tingting, Jiang Xiangao
Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, People's Republic of China.
Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou Sixth People's Hospital, Wenzhou, Zhejiang, 325000, People's Republic of China.
Infect Drug Resist. 2025 Jul 12;18:3459-3470. doi: 10.2147/IDR.S530067. eCollection 2025.
This study aimed to elucidate the epidemiological features, drug resistance patterns, and temporal trends among elderly tuberculosis (TB) patients in Wenzhou, China, from 2014 to 2023, providing insights for targeted TB control strategies.
Data were extracted from 10,993 TB patients registered in the Laboratory Information System of Wenzhou Central Hospital and the Tuberculosis Information Management System of the Chinese Center for Disease Control and Prevention. Patients were divided into elderly (≥60 years, n=2,727) and non-elderly (<60 years, n=8,266) groups. Sociodemographic, clinical, and phenotypic drug susceptibility testing data were analyzed using chi-square tests. Temporal trends in drug resistance were assessed via Joinpoint regression to estimate annual percentage changes (APC).
The elderly group had higher proportions of males (79.65% vs 69.66%), Han ethnicity (99.63% vs 96.35%), and lesions involving ≥3 lung fields (42.35% vs 32.62%), but lower proportions of migrants (20.32% vs 51.20%), urban residents (41.03% vs 53.41%), employed individuals (8.98% vs 32.91%), and pulmonary cavitation (46.75% vs 53.54%). The overall drug-resistant tuberculosis (DR-TB) rate was similar between the elderly and non-elderly groups (20.76% vs 20.30%). However, the elderly group had lower rates of streptomycin (SM) resistance (11.07% vs 12.62%), rifampicin (RFP) resistance (6.20% vs 8.06%), and multidrug-resistant tuberculosis (MDR-TB) (5.39% vs 7.10%). From 2014 to 2023, the overall DR-TB rate among elderly patients decreased from 31.58% to 20.64% (-34.63%), with a significant decline in MDR-TB (APC of -9.9%). Resistance to isoniazid (INH) decreased from 2016 to 2023 (APC -4.0%), and RFP resistance decreased from 2014 to 2021 (APC -10.7%). Significant decreases were also observed among migrant populations (APC -10.1%, 2014-2020), urban residents (APC -8.7%, 2014-2021), and unemployed individuals (APC -4.3%, 2014-2023).
Our study revealed that drug resistance among elderly TB patients in Wenzhou has decreased over the past decade, particularly for MDR-TB and key first-line drugs. However, the elderly group still exhibited distinct epidemiological and drug resistance profiles compared to younger patients. These findings offer clear suggestions for public health policy-making and clinical practice, which can help further reduce the burden of tuberculosis and drug resistance in the elderly population.
本研究旨在阐明2014年至2023年中国温州老年结核病患者的流行病学特征、耐药模式和时间趋势，为针对性的结核病控制策略提供见解。
从温州中心医院实验室信息系统和中国疾病预防控制中心结核病信息管理系统中登记的10993例结核病患者中提取数据。患者分为老年组（≥60岁，n = 2727）和非老年组（<60岁，n = 8266）。使用卡方检验分析社会人口统计学、临床和表型药物敏感性测试数据。通过Joinpoint回归评估耐药性的时间趋势，以估计年度百分比变化（APC）。
老年组男性比例较高（79.65%对69.66%）、汉族比例较高（99.63%对96.35%）、累及≥3个肺野的病变比例较高（42.35%对32.62%），但移民比例较低（20.32%对51.20%）、城市居民比例较低（41.03%对53.41%）、就业个体比例较低（8.98%对32.91%）以及肺空洞形成比例较低（46.75%对53.54%）。老年组和非老年组的总体耐多药结核病（DR-TB）率相似（20.76%对20.30%）。然而，老年组链霉素（SM）耐药率较低（11.07%对12.62%）、利福平（RFP）耐药率较低（6.20%对8.06%）以及耐多药结核病（MDR-TB）率较低（5.39%对7.10%）。2014年至2023年，老年患者的总体DR-TB率从31.58%降至20.64%（-34.63%），MDR-TB显著下降（APC为-9.9%）。对异烟肼（INH）的耐药性在2016年至2023年下降（APC -4.0%），RFP耐药性在2014年至2021年下降（APC -10.7%）。在移民人群（2014 - 2020年，APC -10.1%）、城市居民（2014 - 2021年，APC -8.7%）和失业个体（2014 - 2023年，APC -4.3%）中也观察到显著下降。
我们的研究表明，温州老年结核病患者的耐药性在过去十年中有所下降，特别是耐多药结核病和关键一线药物。然而，与年轻患者相比老年组仍表现出不同的流行病学和耐药特征。这些发现为公共卫生政策制定和临床实践提供了明确建议，有助于进一步减轻老年人群的结核病和耐药负担。
