热带病与寄生虫学

热带病与寄生虫学 ›› 2023, Vol. 21 ›› Issue (2): 65-71.doi: 10.3969/j.issn.1672-2302.2023.02.002

• 结核病控制专题 • 上一篇    下一篇

2016—2020年全国学生耐药肺结核流行特征与治疗转归分析

陈卉1,2(), 宋雅婷3(), 李涛1, 张灿有1, 陈红缨3, 张梦娴4, 周丽平4, 成君1(), 苏伟1()   

  1. 1.中国疾病预防控制中心结核病预防控制中心，北京102206
    2.中国疾病预防控制中心教育培训处现场流行病学培训项目
    3.湖北省疾病预防控制中心
    4.湖北省疾病预防控制中心结核病防治研究所
  • 收稿日期:2023-03-21 出版日期:2023-04-20 发布日期:2023-05-03
  • 通信作者: 成君，E-mail: chengjun@chinacdc.cn；苏伟，E-mail: suwei@chinacdc.cn
  • 作者简介:陈卉，女，硕士，助理研究员，研究方向：结核病控制。E-mail: chenhui@chinacdc.cn|宋雅婷，女，硕士，医师，研究方向：生物统计学方法及应用。E-mail: zqing9@163.com
  • 基金资助:
    中央财政结核病控制项目结核业务日常运转项目(238711)

Epidemiological characteristics and medication outcomes in students with drug-resistant pulmonary tuberculosis in China from 2016 to 2020

CHEN Hui1,2(), SONG Ya-ting3(), LI Tao1, ZHANG Can-you1, CHEN Hong-ying3, ZHANG Meng-xian4, ZHOU Li-ping4, CHENG Jun1(), SU Wei1()   

  1. 1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
    2. Chinese Field Epidemiology Training Program of Education Division, Chinese Center for Disease Control and Prevention
    3. Hubei Provincial Center for Disease Control and Prevention
    4. Institute for Tuberculosis Control and Prevention, Hubei Provincial Center for Disease Control and Prevention
  • Received:2023-03-21 Online:2023-04-20 Published:2023-05-03
  • Contact: CHENG Jun, E-mail: chengjun@chinacdc.cn;SU Wei, E-mail: suwei@chinacdc.cn

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摘要：

目的 分析全国学生人群耐药肺结核流行特征和治疗转归情况，为优化学生肺结核防控措施提供依据。方法 收集2016—2020年在中国疾病预防控制信息系统结核病管理信息系统中登记的全国耐药肺结核学生病例特征信息，应用描述流行病学方法分析其性别、民族、年龄、地区、治疗和转归情况等。结果 2016—2020年全国共登记学生耐药肺结核患者2 541例，其中利福平耐药患者2 469例，占97.17%。登记患者中，男性1 395例（占54.90%），女性1 146例（占45.10%）；汉族2 174例（占85.56%），少数民族367例（占14.44%）；年龄中位数为18（17，20）岁；19岁及以上登记患者最多，为1 206例（占47.46%），其次是16~18岁，为946例（占37.23%），0~12岁最少，为68例（占2.68%）；登记病例数量最多的地区为西部（906例，占35.65%），中部地区登记病例数最少（810例，占31.88%）。以初治的患者为主，为1 869例（占73.55%）。利福平单耐药和多耐药、少数民族、0~18岁和初次治疗的患者占比呈逐年上升趋势（χ2趋势=206.016、18.212、17.433、45.651，P均<0.01）。利福平耐药患者的纳入治疗率为91.58%（2 261/2 469），2016—2020年分别为81.04%（171/211）、85.06%（279/328）、89.77%（500/557）、94.84%（662/698）和96.15%（649/675），呈现逐年上升趋势（χ2趋势=75.340，P <0.01）。利福平耐药患者治疗成功率为74.48%（1 684/2 261），其中16~18岁组治疗成功率最高（77.62%），0~12岁组治疗成功率最低（59.38%），不同年龄组治疗成功率差异有统计学意义（χ2=13.608，P <0.01）；东部地区患者治疗成功率最高（78.46%），中部地区治疗成功率最低（71.29%），不同地区治疗成功率差异有统计学意义（χ2=10.240，P <0.01）；2017—2018年登记的患者治疗成功率较高（77.06%和77.00%），2016年登记的患者治疗成功率最低（66.67%），不同登记年份治疗成功率差异有统计学意义（χ2=9.974，P <0.05）；本地患者的治疗成功率最高（81.04%），市间流动的患者治疗成功率最低（57.62%），不同流动人群治疗成功率差异有统计学意义（χ2=226.854，P <0.01）。结论 2016—2020年学生人群耐药肺结核发现数增加，防治工作取得一定效果，仍存在发现不足的问题。利福平耐药患者纳入治疗率和治疗成功率较高，但需关注丢失等不良结局的患者。建议加大筛查力度，提高检测质量，强化学校、疾控中心、医疗机构之间的合作。

关键词: 肺结核, 学生, 抗药性, 流行特征, 治疗结果

Abstract:

Objective To analyze the epidemic characteristics of drug-resistant tuberculosis (TB) among students, so as to provide evidence for optimizing disease prevention and control measures. Methods The data were obtained from cases of drug-resistant TB in students registered in Tuberculosis Management Information System of China Information System for Disease Control and Prevention from 2016 to 2020. Descriptive epidemiological methods were used to analyze the gender, age, nationality, treatment and prognosis of the patients with drug-resistant TB. Results A total of 2 541 cases of drug-resistant TB were registered in students from 2016 to 2020, in whom 2 469 (97.17%) were patients resistant to rifampin. Of the registered patients, 1 395 (54.90%) were males, and 1 146 (45.10%) females. 2 174 (85.56%) cases were Han nationality, and 367 (14.44%) minorities. The median age was 18 (17, 20) years old, and the infection was most seen in students aged 19 or over, accounting for 1 206(47.46%), followed by those aged 16-18 years (946, 37.23%). Patients aged from 0 to 12 years were least seen (only 68 cases, 2.68%). The registered cases were the highest in the western area (906 cases, 35.65%), while the registered cases were minimal in the central area of China (810 cases, 31.88%). By treatment, patients just underwent initial medication, which accounted for 73.55%. The proportion of patients with single rifampicin resistance and multi-drug resistance, from minority, aged between 0 and 19, and those undergone first medication tended to increase year by year (χ2trend=206.016, 18.212, 17.433, 45.651, all P<0.01). Overall treatment initiation rate of rifampicin-resistant patients was 91.58% (2 261/2 469), respectively 81.04% (171/211), 85.06% (279/328), 89.77% (500/557), 94.84% (662/698)and 96.15% (649/675) from 2016 to 2020, which showed an upward trend annually (χ2trend=75.340, P<0.01). 74.48% (1 684/2 261) of the patients were successfully treated. The successful medication rate was the highest in patients aged 16-18 years (77.62%) and in the eastern area, and the lowest in those aged 0-12(59.38%) and in the central area. The difference was significant in diverse age group (χ2=13.608, P<0.01) and different areas (χ2=10.240, P<0.01). The highest success rate of treatment was seen in the patients registered in between 2017 and 2018, which was 77.06% and 77.00%, respectively, and the lowest was seen in those registered in 2016, which was 66.67%. The difference was significant regarding the successfully medication rate in patients registered in different years (χ2=9.974, P<0.05). The successful medication rate was the highest in local residents, and the lowest in population floating among cities (81.04% vs. 57.62%, χ2=226.854, P<0.01). Conclusion From 2016 to 2020, the number of drug-resistant pulmonary tuberculosis cases detected among students has increased, and the prevention and control efforts has arrived at certain level, yet certain issues still exist. Although the treatment rate and successful medication rate appear higher, yet attention should be paid to the patients with missed therapy or poor prognosis. Therefore, it is suggested to strengthen screening, improve detection quality and strengthen the cooperation between schools, CDC and medical institutions.

Key words: Pulmonary tuberculosis, Student, Rifampicin-resistance, Epidemic characteristic, Treatment outcome

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