文章摘要
陈慧娟,郑旭彬,王芸,李进岚,徐飚.基于肺结核患者耐药风险的筛查策略对耐多药结核病发现效果的评价[J].中华流行病学杂志,2021,42(12):2164-2169
基于肺结核患者耐药风险的筛查策略对耐多药结核病发现效果的评价
Evaluation of screening strategies of multidrug-resistant tuberculosis among pulmonary tuberculosis patients of the different risk levels
收稿日期:2021-01-25  出版日期:2021-12-16
DOI:10.3760/cma.j.cn112338-20210125-00063
中文关键词: 耐多药;结核病;人群归因危险度百分比;筛查策略
英文关键词: Multidrug-resistant;Tuberculosis;Population attributable risk proportion;Screening strategy
基金项目:贵州省耐多药结核病患者就医行为及疾病负担研究国家自然科学基金(81860591);贵州省结核病高疫情地区综合防控模式降低疾病负担模式研究(黔发改规划[2020]181号)
作者单位E-mail
陈慧娟 贵州省疾病预防控制中心结核病防治研究所, 贵阳 550004  
郑旭彬 复旦大学公共卫生学院教育部公共卫生安全重点实验室, 上海 200032  
王芸 贵州医科大学医药卫生管理学院, 贵阳 550001  
李进岚 贵州省疾病预防控制中心结核病防治研究所, 贵阳 550004  
徐飚 贵州医科大学医药卫生管理学院, 贵阳 550001 bxu@shumu.edu.cn 
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中文摘要:
      目的 评价贵州省肺结核患者中的耐多药/广泛耐药结核病(MDR/XDR-TB)发现情况,为进一步优化筛查策略提供科学依据。方法 对贵州省2012-2019年中国疾病预防控制信息系统"结核病管理信息系统"登记报告的耐药监测肺结核病例进行回顾性分析,采用人群归因危险度百分比(PARP)评估不同耐药风险患者对MDR/XDR-TB发现的贡献。结果 在18 506例开展耐药筛查的病例中,男性占68.65%(12 705/18 506),25~54岁占47.69%(8 826/18 506),耐药患者占15.90%(2 943/18 506),MDR/XDR-TB占5.42%(1 003/18 506)。在发现的所有MDR/XDR-TB患者中,耐药高风险人群对病例发现的贡献占一半以上(PARP=57.00%),而不同类别的耐药高风险人群对MDR/XDR-TB发现的贡献不同,其中复发和返回、初治失败、慢性患者/复治失败和2/3个月末痰片涂阳的PARP分别为21.70%、19.49%、11.90%和2.30%。耐药高风险人群中MDR/XDR-TB检出率为15.89%(578/3 637),低风险人群中MDR/XDR-TB检出率为2.86%(425/14 869),差异有统计学意义(P<0.001)。结论 贵州省耐药监测力度及MDR/XDR-TB病例发现水平总体处于上升态势,耐药高风险人群中MDR/XDR-TB的检出率高于低风险人群。
英文摘要:
      Objective To evaluate the detection of MDR-TB and XDR-TB patients and to provide evidence for further improvement of MDR-TB and XDR-TB screening strategy. Methods Patients who were under drug resistance surveillance, registered and reported by the TB Management Information System of the Chinese Disease Prevention and Control Information System from 2012 to 2019 and resided in Guizhou province were retrospectively analyzed. The contribution of five high-risk subgroups to detection of MDR/XDR-TB were evaluated using population attributable risk proportion (PARP). Results Of the 18 506 cases under drug resistance surveillance, patients who were male, aged between 25 and 54 years, with drug-resistant TB or with MDR/XDR-TB accounted for 68.65% (12 705/18 506), 47.69% (8 826/18 506), 15.90% (2 943/18 506) or 5.42% (1 003/18 506), respectively. Five high-risk subgroups made significant contributions to the detection of MDR/XDR-TB with a PARP of 57.00%. Specifically, the PARP were 21.70%, 19.49%, 11.90% and 2.30% for patients that were relapse and return, failed initial treatment, chronic/retreatment failure and smear-positive at the end of the second or third month, respectively. The detection rate of MDR/XDR-TB in high-risk groups was 15.89% (578/3 637) while in low-risk groups was 2.86% (425/14 869). Conclusions Number of patients under drug resistance surveillance and the detection of MDR/XDR-TB trended to increase in Guizhou province from 2012 to 2019. The detection rate of MDR/XDR-TB in high-risk groups was higher than low-risk groups.
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