摘要
目的分析贵州省利福平耐药结核病(rifampicin-resistant tuberculosis,RR-TB)的危险因素及治疗转归情况。方法收集2014年1月至2018年12月贵州省88个县(市、区)的结核病定点医院在中国结核病信息管理系统中登记的有药物敏感试验结果的16548例肺结核患者的临床信息。回顾性分析纳入患者的性别、年龄、职业、民族、患者登记分类、痰培养阳性患者的分子生物学或罗氏固体培养结果,以及治疗转归情况。采用Cohen′s kappa系数分析分子生物学和罗氏固体培养比例法对利福平耐药检出能力的一致性,χ^(2)检验和非条件logistic回归方法分析单耐利福平和耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)的危险因素及治疗转归的影响因素。计量资料比较采用χ^(2)检验或Fisher确切概率法。结果初治肺结核患者中RR-TB占6.79%(807/11883),复治患者中RR-TB占30.01%(1400/4665)。用罗氏固体培养比例法和分子生物学同时对184例RR-TB患者标本进行药物敏感试验,利福平耐药率分别为20.65%(38/184)和16.85%(31/184),两种方法检测利福平耐药一致性较好[kappa=0.697,95%可信区间(confidence interval,CI)0.564~0.830,P<0.01]。logistic回归多因素分析显示,年龄为20~39岁组[比值比(odds ratio,OR)=1.679,95%CI 1.134~2.487]和40~60岁组(OR=1.526,95%CI 1.019~2.283)是发生MDR-TB的高危年龄组。抗结核治疗失败(OR=27.753,95%CI 22.455~34.300;OR=2.982,95%CI 1.544~5.760)、复发和返回(OR=5.381,95%CI 4.563~6.346;OR=3.897,95%CI 2.901~5.234)均是发生MDR-TB和单耐利福平肺结核的高危因素。2014年至2016年RR-TB患者纳入治疗率为39.96%(396/991),治愈率为34.85%(138/396),病死率为4.04%(16/396)。年龄>60岁的RR-TB患者治愈率和病死率分别为12.68%(9/71)和11.27%(8/71),分别与年龄≤60岁患者的39.69%(129/325)和2.46%(8/325)比较,差异均有统计学意义(χ^(2)=18.732,P<0.01;Fisher确切概率法,P=0.003)。结论贵州省RR-TB患者以复治为主,年龄为20~60岁和既往抗结核治疗情况是RR-TB的高危因素,年龄>60岁的RR-TB患者治愈率较低,病死率较高,应重视RR-TB患者的筛查、治疗和管理,减少疾病传播。
Objective To explore the risk factors and the treatment outcomes of rifampicin-resistant tuberculosis(RR-TB)in Guizhou Province.Methods The clinical data of 16548 pulmonary tuberculosis patients with drug sensitivity test results registered in the Tuberculosis Information Management System in China from designated tuberculosis hospitals of 88 counties(cities,districts)in Guizhou Province from January 2014 to December 2018 were collected.The gender,age,occupation,ethnicity,patient registration classification,molecular biology or Lowenstein-Jenden(L-J)solid culture results of positive sputum culture patients,and treatment outcomes were retrospectively analyzed.Cohen′s kappa coefficient was used to analyze the consistency between molecular biology and L-J solid culture in detecting rifampin resistance.Chi-square test and non-conditional logistic regression model were used to analyze the risk factors of mono-rifampicin resistance tuberculosis and multidrug-resistant tuberculosis(MDR-TB)and the factors affecting treatment outcomes.The measurement data were compared by chi-square test or Fisher exact test.Results The detection rate of RR-TB in the newly diagnosed cases was 6.79%(807/11883),and that in the retreated cases was 30.01%(1400/4665).The drug sensitivity tests of 184 sputum culture positive RR-TB samples were performed by both L-J solid culture and molecular biology,and the rifampicin resistance detection rates were 20.65%(38/184)and 16.85%(31/184),respectively.The consistency between two methods was good(kappa=0.697,95%confidence interval(CI)0.564-0.830,P<0.01).Multivariate logistic regression analysis showed that patients aged 20 to 39 years old(odds ratio(OR)=1.679,95%CI 1.134-2.487)and aged 40 to 60 years old(OR=1.526,95%CI 1.019-2.283)were the high risk groups for MDR-TB.Treatment failure(OR=27.753,95%CI 22.455-34.300;OR=2.982,95%CI 1.544-5.760,respectively),relapse and return(OR=5.381,95%CI 4.563-6.346;OR=3.897,95%CI 2.901-5.234,respectively)were both high risk factors for MDR-TB and mono-rifampicin resistance tuberculosis.The treatment rate of RR-TB patients was 39.96%(396/991)from 2014 to 2016.Among 396 treatment cases,138(34.85%)were cured and 16(4.04%)died.The patients aged>60 years old had lower cure rate(12.68%(9/71)vs 39.69%(129/325))and higher death rate(11.27%(8/71)vs 2.46%(8/325))than those aged≤60 years.The differences were both statistically significant(χ^(2)=18.732,P<0.01;Fisher′s exact test,P=0.003).Conclusions The RR-TB patients in Guizhou Province are mainly re-treated.Young and middle-age(20-60 years old)and treatment history are risk factors for RR-TB.The patients over 60 years old have a low cure rate and a high mortality rate.It is suggested to strengthen the screening,treatment and management of RR-TB to reduce the spread of tuberculosis.
作者
何昱颖
胡屹
陈玮
李进岚
He Yuying;Hu Yi;Chen Wei;Li Jinlan(Institute for Tuberculosis Control,Guizhou Center for Disease Control and Prevention,Guiyang 550004,China;School of Pubic Health,Fudan University,Shanghai 200032,China)
出处
《中华传染病杂志》
CAS
CSCD
2021年第5期289-294,共6页
Chinese Journal of Infectious Diseases
基金
国家自然科学基金(81874273)。
关键词
利福平
结核
危险因素
耐药性
转归
Rifampin
Tuberculosis
Risk factors
Drug-resistant
Outcome
