2012—2016年南宁市耐多药肺结核高危人群筛查情况分析
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摘要
目的了解南宁市高危人群耐多药肺结核筛查情况,探索并完善耐多药肺结核患者的发现策略。方法以耐多药肺结核5类高危人群为主要筛查对象,进行结核菌培养和药敏试验,分析不同人群中耐多药肺结核的筛出情况。结果 2012—2016年南宁市登记高危人群肺结核可疑患者2 061例,完成耐药筛查1 240例,筛查率60.16%。涂阳培阳率51.45%,涂阳培阴率47.10%,污染率1.45%;其中复治失败患者涂阳培阳率最高,为76.92%,初治2/3月末阳性患者涂阳培阳率最低,仅为30.17%。各年度的涂阳培阳率呈下降趋势,由2012年的59.68%下降至2016年的43.85%。培养阳性中有562例为结核分枝杆菌复合群,检出耐多药肺结核170例,检出率为30.25%。不同患者分类耐多药检出率的差异总体上有统计学意义(χ2=33.403,P<0.001),其中复治失败检出率最高(55.17%),其次为初治失败52.24%,初治2/3月末阳性最低(20.62%)。耐多药检出率逐年下降,由2012年的41.18%下降至2016年的20.69%。结论对重点人群优先进行筛查是非常有效的耐多药肺结核患者发现策略,但该市实验室能力不足问题比较突出,需引起高度重视,切实加强实验室能力建设,不断提高痰菌培养阳性率。
Objective This study was designed to understand the screening situation of suspicious multi-drug resistant tuberculosis cases and explore the suitable case-finding strategy.Methods Five types of high-risk groups with multi-drug resistant tuberculosis were screened by drug susceptible test,and the rate of confirmed MDR-TB and XDR-TB in different groups was calculated.Result In 2012-2016,there were 2 061 cases of tuberculosis patients were registered in high-risk population in Nanning,and 1 240 cases of drug resistance screening were completed,with a screening rate of 60.16%.The rate of smear-positive and culture-positive rate was 51.45%,the rate of smear-receiving was 47.1%,and the pollution rate was 1.45%.Among them,the patients with failed retreatment had the highest rate of smear-positive,which was 76.92%; the culture positive rate of initial treatment positive patients at the end of 2 or 3 months was the lowest,which was only 30.17%.The annual sputum smear-positive and culture-positive rate showed a downward trend,from 59.68% in 2012 to 43.85% in 2016.Among the culture-positive cases,562 were Mycobacterium tuberculosis complexes,and 170 cases of multidrug-resistant drugs were detected.The detection rate was 30.25%.The difference in the multidrug-recovery rate of different patients was statistically significant(χ~2=33.403,P<0.001),of which the highest detection retreatment failure rate was 55.17%,followed by the initial treatment failure rate 52.24%,and the initial treatment smear-positive rate at the end of 2 or 3 months was the lowest,which was 20.62%.The detection rate of multidrug-resistant drugs decreased year by year,from 41.18% in 2012 to 20.69% in 2016.Conclusion Screening priority for the key populations is an effective strategy for finding multidrug-resistant tuberculosis patients.However,the lack of laboratory capacity in the city is problematic and needs to be paid attention.It is necessary to strengthen the laboratory capacity and continuously improve the positive rate of sputum culture.
Objective This study was designed to understand the screening situation of suspicious multi-drug resistant tuberculosis cases and explore the suitable case-finding strategy.Methods Five types of high-risk groups with multi-drug resistant tuberculosis were screened by drug susceptible test,and the rate of confirmed MDR-TB and XDR-TB in different groups was calculated.Result In 2012-2016,there were 2 061 cases of tuberculosis patients were registered in high-risk population in Nanning,and 1 240 cases of drug resistance screening were completed,with a screening rate of 60.16%.The rate of smear-positive and culture-positive rate was 51.45%,the rate of smear-receiving was 47.1%,and the pollution rate was 1.45%.Among them,the patients with failed retreatment had the highest rate of smear-positive,which was 76.92%; the culture positive rate of initial treatment positive patients at the end of 2 or 3 months was the lowest,which was only 30.17%.The annual sputum smear-positive and culture-positive rate showed a downward trend,from 59.68% in 2012 to 43.85% in 2016.Among the culture-positive cases,562 were Mycobacterium tuberculosis complexes,and 170 cases of multidrug-resistant drugs were detected.The detection rate was 30.25%.The difference in the multidrug-recovery rate of different patients was statistically significant(χ~2=33.403,P<0.001),of which the highest detection retreatment failure rate was 55.17%,followed by the initial treatment failure rate 52.24%,and the initial treatment smear-positive rate at the end of 2 or 3 months was the lowest,which was 20.62%.The detection rate of multidrug-resistant drugs decreased year by year,from 41.18% in 2012 to 20.69% in 2016.Conclusion Screening priority for the key populations is an effective strategy for finding multidrug-resistant tuberculosis patients.However,the lack of laboratory capacity in the city is problematic and needs to be paid attention.It is necessary to strengthen the laboratory capacity and continuously improve the positive rate of sputum culture.
引文
[1]World Health Organization.Global tuberculosis report2017[M].Geneva:WHO,2017:21-63.
[2]李静,沈鑫,张阳奕,等.上海地区MDR-TB患者二线药物耐药危险因素分析[C]//2011年中国防痨协会全国学术会议论文集,中国广西桂林,2011:8-12.
[3]郭颖,许钦龙.110株结核分枝杆菌二线药敏结果分析[J].临床肺科杂志,2011,16(8):1279-1280.
[4]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006:46-51.
[5]张欢,王莉丽,鲍远松,等.合肥市耐多药肺结核可疑者筛查状况分析[J].安徽预防医学杂志,2014,20(6):437-439.
[6]李君,朱小梅,毛玲琼,等.温州市2014-2015年耐多药肺结核高危人群筛查情况分析[J].中国公共卫生管理,2017,33(3):345-347.
[7]吴哲渊,张青,张祖荣,等.上海市耐多药肺结核防治管理模式效果评价[J].中国防痨杂志2015,37(11):1118-1125.
[8]徐彩红,马伟,李仁忠,等.耐多药肺结核患者发现和纳入治疗情况分析[J].中国预防医学杂志,2014,15(6):546-549.
[9]马慧芬,孔鹏,孟庆跃.耐多药结核病治疗管理模式现状[J].医学与哲学,2012,33(6):74-76.
[10]马艳,尹韶华,杜建,等.383例耐药肺结核患者的相关危险因素分析[J].结核病与肺部健康杂志,2016,5(2):128-134.
[11]Faustini A,Hall AJ,Perucci CA.Risk factors for multidrug resistant tuberculosis in Europe:a systematic review[J].Thorax,2006,61(2):158-163.
[2]李静,沈鑫,张阳奕,等.上海地区MDR-TB患者二线药物耐药危险因素分析[C]//2011年中国防痨协会全国学术会议论文集,中国广西桂林,2011:8-12.
[3]郭颖,许钦龙.110株结核分枝杆菌二线药敏结果分析[J].临床肺科杂志,2011,16(8):1279-1280.
[4]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006:46-51.
[5]张欢,王莉丽,鲍远松,等.合肥市耐多药肺结核可疑者筛查状况分析[J].安徽预防医学杂志,2014,20(6):437-439.
[6]李君,朱小梅,毛玲琼,等.温州市2014-2015年耐多药肺结核高危人群筛查情况分析[J].中国公共卫生管理,2017,33(3):345-347.
[7]吴哲渊,张青,张祖荣,等.上海市耐多药肺结核防治管理模式效果评价[J].中国防痨杂志2015,37(11):1118-1125.
[8]徐彩红,马伟,李仁忠,等.耐多药肺结核患者发现和纳入治疗情况分析[J].中国预防医学杂志,2014,15(6):546-549.
[9]马慧芬,孔鹏,孟庆跃.耐多药结核病治疗管理模式现状[J].医学与哲学,2012,33(6):74-76.
[10]马艳,尹韶华,杜建,等.383例耐药肺结核患者的相关危险因素分析[J].结核病与肺部健康杂志,2016,5(2):128-134.
[11]Faustini A,Hall AJ,Perucci CA.Risk factors for multidrug resistant tuberculosis in Europe:a systematic review[J].Thorax,2006,61(2):158-163.