2018~2022年浙江北部结核分枝杆菌耐药情况及流行特征分析

Characterization of Drug Resistance and Prevalence of Mycobacterium tuberculosis in Northern Zhejiang, 2018~2022

摘要: 目的：了解浙江北部结核分枝杆菌(Mycobacterium tuberculosis, MTB)耐药情况，为临床结核病治疗及该地区结核病防控提供依据。方法：选取2018~2022年杭州市结核病定点医院(杭州师范大学附属医院)收治的2539例肺结核患者作为研究对象，采集肺结核患者的性别、年龄及对异烟肼(INH)利福平(RIF)、链霉素(SM)、乙胺丁醇(EMB)一线抗结核药物和对氧氟沙星(OFX)、卡那霉素(Km)、卷曲霉素(Cm)、丁胺卡那霉素(Am)、丙硫异烟胺(PTO)、对氨基水杨酸(PAS)二线抗结核药物的耐药情况等临床资料进行数据整理，使用SPSS26.0统计软件进行χ2检验，以P < 0.05为差异有统计学意义。结果：2018~2022年的2539例肺结核患者中，耐药的有177例，总耐药率为6.97%；72例耐多药，耐多药率为2.84%；132例利福平耐药，耐药率为5.20%；一线抗结核药物耐药顺序：RIF > INH > SM > EMB；二线抗结核药物耐药顺序：OFX > Am > Cm > PTO > Km = PAS；肺结核初治和复治患者总耐药率分别为6.10%、14.67%，耐多药率分别为2.41%、6.56%，差异均具有统计学意义(P < 0.001)；男、女肺结核患者总耐药率分别为7.22%、6.44%，耐多药率分别为2.95%、2.60%，差异均无统计学意义(P > 0.05)；2018~2022年总耐药率分别为6.57%、7.45%、8.60%、6.26%、6.07%，差异无统计学意义；20~40岁年龄段结核患病人数及耐药率最高；2020~2022年广泛耐药占总耐药比例分别为2.56%、9.09%、10.34%，呈递增趋势。结论：浙江省北部结核分枝杆菌总耐药率、耐多药率均低于全国平均水平，但复治肺结核患者总耐药率和耐多药率较初治显著升高，需进一步研究耐药病例合理的化疗方案，重点加强对结核病初、复治患者的治疗管理，从源头上减少结核耐药的发生。

Abstract: Objective: To understand the drug-resistant status of Mycobacterium tuberculosis (MTB) in north-ern Zhejiang, and to provide a basis for clinical tuberculosis treatment and tuberculosis prevention and control in this region. Methods: 2539 pulmonary tuberculosis patients admitted to the desig-nated tuberculosis hospital in Hangzhou (Affiliated Hospital of Hangzhou Normal University) from 2018 to 2022 were selected as the research subjects. The gender, age, and response to isoniazid (INH), rifampicin (RIF), Mycomycin (SM), ethambutol (EMB) first-line anti-tuberculosis drugs and ofloxacin (OFX), kanamycin (Km), capreomycin (Cm), amikacin (Am), prothionamide (PTO), and pa-ra-aminosalicylic acid (PAS) second-line anti-tuberculosis drugs resistance status and other clinical data were compiled, and SPSS26.0 statistical software was used to conduct χ2 test, with P < 0.05 as the difference was statistically significant. Results: Among the 2539 tuberculosis patients from 2018 to 2022, 177 cases were drug-resistant, and the total drug resistance rate was 6.97%; the multidrug resistance rate of 72 cases was 2.84%. The drug resistance rate of 132 cases of rifampicin resistance was 5.20%. The first-line anti-tuberculosis drug resistance order: RIF > INH > SM > EMB; the order of second-line anti-tuberculosis drug resistance: OFX > Am > Cm > PTO > Km = PAS; the total drug resistance rates of the first treatment and the retreatment of pulmonary tuberculosis pa-tients were 6.10%, 14.67%, 2.41% and 6.56%, respectively, the difference was statistically signifi-cant (P < 0.001); the total drug resistance rates of male and female pulmonary tuberculosis patients were 7.22%, 6.44%, 2.95% and 2.60%, respectively, and there was no significant difference (P > 0.05); the total drug resistance rates from 2018 to 2022 were 6.57%, 7.45%, 8.60%, 6.26% and 6.07%, respectively. There was no significant difference. The 20~40 age group has the highest tu-berculosis prevalence and drug resistance rate; from 2020 to 2022, the proportion of extensive drug resistance to total drug resistance was 2.56%, 9.09% and 10.34%, respectively, showing an increasing trend. Conclusions: The total drug resistance rate and multidrug resistance rate of My-cobacterium tuberculosis in northern Zhejiang Province are lower than the national average, but the total drug resistance rate and multidrug resistance rate of retreated tuberculosis patients are sig-nificantly higher compared with those of primary treatment, which calls for further research on ra-tional chemotherapy regimens for drug-resistant cases, focus on strengthening treatment man-agement for first-time and repeat tuberculosis patients, and reducing tuberculosis drug resistance at its source.