热带病与寄生虫学

热带病与寄生虫学 ›› 2026, Vol. 24 ›› Issue (2): 85-90.

• 结核病防控专题 • 上一篇    下一篇

2013—2024年重庆市结核病耐药监测点监测结果分析

余敏，余锋平，吴成果，冯鑫，游国庆，周雪，范君，胡彦   

  1. 重庆市结核病防治所，重庆400050

  • 收稿日期:2025-09-25 出版日期:2026-04-20 发布日期:2026-05-29
  • 通信作者: 范君，E-mail: 17540024@qq.com；胡彦，E-mail: huyanz025@163.com
  • 作者简介:余敏，女，硕士，技师，研究方向：结核病诊断。E-mail: 1056055722@qq.com 余锋平，女，本科，主管检验技师，研究方向：结核病诊断。E-mail: 12554418331@qq.com 余敏和余锋平同为第一作者

The monitoring results at tuberculosis drug resistance surveillance sites in Chongqing Municipality, 2013-2024

YU Min, YU Fengping, WU Chengguo, FENG Xin, YOU Guoqing, ZHOU Xue, FAN Jun, HU Yan   

  1. Chongqing Tuberculosis Prevention and Control Institute, Chongqing 400050, China
  • Received:2025-09-25 Online:2026-04-20 Published:2026-05-29
  • Supported by:
    重庆市技术创新与应用发展专项（CSTB2024TIAD-GPX0018）；重庆市九龙坡区科技计划项目（2024-04-008-Z）；重庆市科卫联合医学科研项目（2024ZDXM020）

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摘要：

摘要：目的 了解重庆市结核病耐药监测点监测结果，为耐药结核病的防控提供参考。方法 收集2013—2024年重庆市丰都县、奉节县2个国家级结核病耐药监测点的监测资料，分析结核病病原学阳性患者对异烟肼（isoniazid, INH）、利福平（rifampicin, RFP）、链霉素（streptomycin, Sm）、乙胺丁醇（ethambutol, EMB）、氧氟沙星（ofloxacin, Ofx）和卡那霉素（kanamycin, Km）6种常见抗结核药物的耐药类型、种类、谱系情况，并采用Joinpoint回归模型对耐药趋势进行分析。结果 研究共纳入2 144例结核病患者，总耐药率为19.96%（428/2 144），耐多药率为4.34%（93/2 144）。复治患者耐药率和耐多药率（34.88%，14.73%）高于初治患者（17.92%，2.92%）（χ2=40.869、76.316，P均<0.05）；接尘人员/尘肺病史患者的耐药率（30.00%）高于非接尘人员/尘肺病史患者（19.15%）（χ2=10.903，P<0.05）。6种抗结核药物的耐药顺位从高到低依次为Sm（9.98%，214/2 144）、INH（9.75%，209/2 144）、Ofx（6.11%，131/2 144）、RFP（5.64%，121/2 144）、EMB（2.75%，59/2 144）和Km（2.10%，45/2 144）；耐药谱系以Ofx单耐药最为常见（3.78%，81/2 144）。2013—2024年监测点耐多药率呈下降趋势（AAPC=-6.581，P<0.05），Km和Ofx的耐药率呈上升趋势（AAPC=13.934、11.862，P均<0.05）。奉节县监测点总耐药率、耐多药率、准广泛耐药率，INH、RFP、EMB、Ofx耐药率均高于丰都县（χ2=9.822、13.035、12.191、6.811、7.349、12.650、23.102，P均<0.05）。结论 重庆市结核病耐药形势依然严峻，其中Ofx单耐药最为常见，二线抗结核药物耐药率呈上升趋势，复治患者、接尘及有尘肺病史患者发生耐药的风险更高。今后需强化二线抗结核药物耐药筛查，加强重点人群的耐药监测与规范化诊疗管理。

关键词: 结核分枝杆菌, 抗药性, 监测, 重庆市

Abstract:

Abstract:Objective  To understand the surveillance results at the tuberculosis drug resistance surveillance sites in Chongqing area for a reference for following prevention and control of drug-resistant tuberculosis. Methods  The surveillance data were collected from 2013 to 2024 from the two national-level tuberculosis drug resistance surveillance sites in Fengdu County and Fengjie County of Chongqing, and analyzed regarding the drug resistance patterns, categories and spectrums of six common anti-tuberculosis drugs: isoniazid (INH), rifampicin (RFP), streptomycin (Sm), ethambutol (EMB), ofloxacin (Ofx) and kanamycin (Km) among the patients with etiologically confirmed positive tuberculosis. The Joinpoint regression model was used to analyze the trends in drug resistance. Results  A total of 2 144 tuberculosis patients were included in the study. The overall drug resistance rate was 19.96% (428/2 144), and the multidrug resistance rate accounted for 4.34% (93/2 144). The rate of drug resistance and multidrug resistance were significantly higher in retreated patients than in primary treated patients (34.88% vs. 17.92%, 14.73% vs. 2.92%; χ2= 40.869, 76.316, respectively; both P<0.05). Patients with a history of dust exposure or pneumoconiosis exhibited a higher drug resistance rate than those without such history (30.00% vs. 19.15%, χ2=10.903, P<0.05). The resistance rate for the six drugs ranking from high to low was Sm (9.98%, 214/2 144), INH (9.75%, 209/2 144), Ofx (6.11%, 131/2 144), RFP (5.64%, 121/2 144), EMB (2.75%, 59/2 144), and Km (2.10%, 45/2 144). In terms of drug resistance spectrum, the most prevalent drug resistance profile was mono-resistance to Ofx (3.78%, 81/2 144). From 2013 to 2024, the multidrug resistance rate exhibited a decreasing trend (AAPC=-6.581, P<0.05), yet the resistance rates of Km and Ofx showed an upward trend (AAPC=13.934 and 11.862, respectively; both P<0.05). The overall drug resistance, multidrug resistance rates,  pre-extensively drug resistance rates and the resistance rates to INH, RFP, EMB and Ofx at the surveillance site in Fengjie County were all significantly higher than those at the site of Fengdu County  (χ2=9.822, 13.035, 12.191, 6.811, 7.349, 12.650 and 23.102, respectively; all P<0.05). Conclusion  The drug resistance situation of tuberculosis in Chongqing remains severe. Among them, single resistance to Ofx is the most common, and the drug resistance rate of second-line anti-tuberculosis drugs shows an upward trend. The risk of drug resistance is higher in retreated patients as well as those exposed to dust or with a history of pneumoconiosis. In the future, it is necessary to strengthen the screening of drug resistance to second-line anti-tuberculosis drugs, and enhance the monitoring and standardized diagnosis and treatment management of drug resistance in the key populations. 

Key words: Mycobacterium tuberculosis, Drug resistance, Surveillance, Chongqing Municipality