2016－2018年中国西部地区结核分枝杆菌耐药率及影响因素分析

杜巧丽; 杜昌廷; 杨健; 王晓平; 王朝才; 闫双群; 王胜芬; 赵雁林

doi:10.3784/jbjc.202010290446

摘要:

目的了解中国西部地区2016 — 2018年结核分枝杆菌耐药情况及对产生耐药结核病的影响因素进行分析，为制定耐药结核病防控措施提供科学的依据。

方法选取2016 — 2018年重庆市丰都县、重庆市奉节县、陕西省未央区、云南省通海县、青海省海西格尔木市、宁夏海原县6个国家耐药监测点收集的843例涂阳肺结核患者为研究对象，采用生化方法对患者分离菌株进行菌种鉴定，结核分枝杆菌复合群菌株采用比例法进行药物敏感性试验，分析不同监测点、时间耐药率的差异。采用统一的调查问卷获得人口学、患者类型等信息，通过单因素和多因素分析耐药结核病产生的危险因素，单因素分析采用χ²检验，多因素分析采用二项logistic回归模型。

结果 843株结核分枝杆菌对6种抗结核药的总耐药率和耐多药率分别是23.13%和6.17%。各抗结核药物的任一耐药顺位由高到低依次为链霉素（SM，13.29%）、异烟肼（INH，13.05%）、利福平（RFP，9.37%）、氧氟沙星（OFX，5.69%）、乙胺丁醇（EMB，4.39%）、卡那霉素（KM，1.42%），不同年份之间结核分枝杆菌株的总耐药率（2016年为22.41%；2017年为26.69%；2018年为20.59%）差异均无统计学意义（P>0.05）。根据西部6个监测点任一耐药率比较结果显示，陕西省未央区对INH、RFP、SM、OFX耐药率都最高，分别为22.29%、20.57%、23.43%和12.00%；青海省海西格尔木市对EMB的耐药率最高，耐药率为10.91%，云南省通海县对KM的耐药率最高地区，耐药率为5.66%，差异均有统计学意义（P<0.05）。单因素分析结果显示，患者类型（χ²=7.736，P=0.005）、性别（χ²=4.149，P=0.042）、现住址（χ²=9.112，P=0.03）、文化程度（χ²=15.182，P=0.004）为患者耐药的危险因素，纳入多因素logistic回归模型，结果显示，男性、复治、陕西省未央区监测点是耐药发生的危险因素（P<0.05）。

结论西部地区，特别是陕西省未央区耐药情况较为严峻，应加强结核病耐药性监测，以指导临床用药和预防控制耐药结核病的发生和流行。

Abstract:

Objective To understand the drug resistance of Mycobacterium tuberculosis in western China from 2016 to 2018, analyze the risk factors for drug-resistance pulmonary tuberculosis (TB), and provide the scientific evidences for TB prevention and control.

Methods A total of 843 smear-positive pulmonary TB cases reported in 6 TB drug resistance areas in western China, i.e. Fengdu and Fengjie counties of Chongqing, Weiyang district of Shaanxi, Tonghai county of Yunnan, Golmud city of Qinghai and Haiyuan county of Ningxia during 2016–2018 were studied. The biochemical identification and drug susceptibility test with proportional method of all the M. tuberculosis strains isolated from these cases were conducted. An unified questionnaire was used to collect the information about cases’ demographic characteristics and disease type.Univariate analysis (χ² test) and multivariate analysis (Logistic regression analysis) were conducted to identify the risk factors associated with drug resistance of TB.

Result The overall drug resistance rate and multidrug resistance rate of the 843 M. tuberculosisstrains to six anti-TB drugs were 23.13% and 6.17%,respectively. The drug resistance rate to streptomycin was highest (13.29%), followed by isoniazide (13.05%), rifampicin (9.37%), ofloxacin (5.69%), ethambutol (4.39%), and , kanamycin (1.42%). The differences in overall drug resistance rate among different year (22.41% in 2016, 26.69% in 2017, 20.59% in 2018) were not significant. Among 6 surveillance areas in west China, the single drug resistance rates to isoniazide, rifampicin, streptomycin and ofloxacin was highest in Weiyang district of Shaanxi, which were 22.29%, 20.57%, 23.43% and 12.00%, respectively, the resistance rate to ethambutol rate in Golmud city of Qinghai was highest (10.91%), the resistance rate to kanamycin in Tonghai county of Yunnan was highest (5.66%). the differences were all significant. The univariate analysis indicated that disease of type ( χ²=7.736, P=0.005), gender ( χ²=4.149, P=0.042), residence ( χ²=9.112, P=0.03), level of education ( χ²=15.182, P=0.004) were the factors associated with TB drug resistance.Multivariate analysis indicated that gender, retreatment, and drug surveillance point were the risk factors associated with TB drug resistance.

Conclusion The TB drug resistance was relatively severe in west China, especially in Weiyang district of Shaanxi. It is necessary to strengthen the TB drug resistance surveillance and promote rational use of anti-TB drugs for the prevention and control of drug-resistant TB.

2016－2018年中国西部地区结核分枝杆菌耐药率及影响因素分析

Drug resistance rate of Mycobacterium tuberculosis and risk factors in western China, 2016–2018