2014–2020年广东省老年人结核病的耐药特征分析

doi:10.19871/j.cnki.xfcrbzz.2023.05.002

摘要/Abstract

摘要： 目的探讨2014–2020年广东省老年人结核病（≥60岁）分离株的耐药情况和不同来源的结核分枝杆菌（mycobacterium tuberculosis,MTB）耐药特征。方法收集2014年1月至2020年12月从32个广东省结核病耐药监测哨点分离的老年人MTB菌株。按照比例法对一线和二线抗结核药物[包括异烟肼（isoniazid,INH）、乙胺丁醇（ethambutol,EMB）、利福平（rifampicin,RFP）、链霉素（streptomycin,Sm）和卡那霉素（kanamycin,Km）、卷曲霉素（capreomycin,Cm）、丙硫异烟胺（protionamide,Pto）、氧氟沙星（ofloxacin,Ofx）、对氨基水杨酸钠（sodium p-aminosalicylate,PAS）]进行药物敏感性试验,对MTB的耐药情况进行分析。结果 2014–2020年共分离9590株老年人MTB菌株,占总MTB检出数的24.6% （9590/39 046）,年度间的MTB检出率存在显著差异（P_趋势<0.001）,MTB的耐药率、单耐药率、多耐药率、耐多药率和广泛耐药率分别为26.7%、13.0%、5.0%、5.0%和2.1%,单耐药率、耐多药率和广泛耐药率年度间的分布存在差异性（均P<0.05）。老年女性结核病耐多药率和广泛耐药率显著高于男性（均P<0.05）,珠三角地区老年人结核分枝杆菌多耐药率、耐多药率和广泛耐药率均显著高于粤东西北地区（均P<0.05）。MTB对一线和二线抗结核药物的耐药率从高到低依次为Sm（14.9%）>INH（11.6%）> EMB（7.5%）>RFP（7.1%）>Ofx（5.8%）>PAS（5.0%）>Pto（4.6%）>Cm（4.0%）>Km（3.7%）,除EMB和Pto外,上述9种一线和二线抗结核药物的耐药率年度趋势间差异有统计学意义（均P_趋势<0.05）。复治患者MTB的广泛耐药率显著高于初治患者（P=0.006）。结论广东省老年人结核病的耐药率较高,珠三角地区居住、老年女性及复治结核病患者MTB耐药情况应引起临床工作者的重视。

关键词: 结核分枝杆菌, 监测, 老年人, 耐药性

Abstract: Objective To investigate the drug resistance of tuberculosis (TB) strains isolated from elderly patients (aged≥60 years) in Guangdong Province from 2014 to 2020 and to evaluate the characteristics of drug resistance of Mycobacterium tuberculosis (MTB) from different sources. Method MTB strains in elderly patients were collected from 32 sentinel sites of TB resistance surveillance in Guangdong province from January, 2014 to December, 2020.Drug sensitivity tests for first - and second-line of anti-tuberculosis drugs [including isoniazid (INH), ethambutol (EMB), rifampicin (RFP), streptomycin (Sm) and kanamycin (Km), capreomycin (Cm), protionamide (Pto), ofloxacin (Ofx), sodium p-aminosalicylate (PAS)] were conducted according to a proportional method. The data of drug resistance of TB was analyzed. Result A total of 9590 MTB isolates were collected during 2014-2020, accounting for 24.6% of the total detection rate of MTB (9590/39046). There was significant difference in the detection rate of MTB during study period (P_trend<0.001).The drug resistance rate, monoresistance rate, polyresistance rate, multidrug resistance rate (MDR) and extensively drug resistance rate (XDR) of MTB was 26.7%, 13.0%, 5.0%, 5.0%, and 2.1%, respectively. There was significant difference in the the distribution of monoresistance rate, MDR rate and XDR rate of MTB during study period (P<0.05). The rates of MDR and XDR in female patients were significantly higher than those in male patients (P<0.05), the rates of polyresistance rate, MDR and XDR in elderly patients living in the Pearl River Delta region were significantly higher than those living in eastern and northwestern Guangdong province (P<0.05). The resistance rate of the isolates to any one of the first- and second-line anti-tuberculosis drugs from high to low was Sm(14.9%)>INH(11.6%)>EMB(7.5%)>RFP(7.1%)>Ofx(5.8%)>PAS(5.0%)>Pto(4.6%)>Cm(4.0%)>Km(3.7%). Except for EMB and Pto, the distribution of those 9 drug resistance rate of MTB during study period was significance (P_trend<0.05). The XDR of MTB in retreated patients was significantly higher than that in initially treated patients (P=0.006). Conclusion The drug resistance rate of TB in elder patients is high. The MTB resistance in patients whom living in Pearl River Delta, whom were female and whom were retreated patients should be paid special attention by clinical workers.

Key words: Mycobacterium tuberculosis, Surveillance, Elderly patients, Drug resistance

中图分类号:

R521

卓文基, 张晨晨, 陈珣珣, 陈燕梅, 余美玲, 魏文静, 徐镠粤, 彭柯皓, 赖晓宇. 2014–2020年广东省老年人结核病的耐药特征分析[J]. 新发传染病电子杂志, 2023, 8(5): 6-10.

Zhuo Wenji, Zhang Chenchen, Chen Xunxun, Chen Yanmei, Yu Meiling, Wei Wenjing, Xu Liaoyue, Peng Kehao, Lai Xiaoyu. Analysis of drug resistance characteristics in elderly tuberculosis of Guangdong province from 2014-2020[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 6-10.

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