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Article(id=1240375111598010390, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311306, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700064000000, receivedDateStr=2023-11-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658071660, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658071660, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658071660, creator=13701087609, updateTime=1773658071660, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1099, endPage=1104, ext={EN=ArticleExt(id=1240375111895805994, articleId=1240375111598010390, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analyses of epidemiological characteristics and treatment outcomes of rifampicin-resistant tuberculosis in elderly patients in Chongqing, 2011-2022, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the epidemiological characteristics and treatment outcomes of elderly patients with rifampicin-resistant tuberculosis (RR-TB) in Chongqing, and to provide evidence for the formulation of prevention and control policies for drug-resistant tuberculosis in elderly population in Chongqing. MethodsData of RR-TB patients registered in Chongqing from 2011 to 2022 were collected through the tuberculosis surveillance module of National Health Security Information Project-Disease Prevention and Control Information System. Then, RR-TB patients over 65 years were screened. Retrospectively, descriptive epidemiological methods were used to analyze the epidemiological characteristics and treatment outcomes of elderly patients with RR-TB, and to compare them with RR-TB in the whole population.

Results

A total of 5 797 RR-TB patients were registered in Chongqing from 2011 to 2022, among which 885 were over 65 years old, accounting for 15.27%. The annual average patient registration rate of elderly RR-TB patients was 1.81/100 000, showed an increasing trend year by year.(,P<0.05). The elderly RR-TB patients were mainly male (80.90%), local population(75.03%), farmers (56.61%) and re-treatment (57.18%). The elderly RR-TB patients of local population, farmers and newly diagnosed patients increased year by year (,22.904,21.581, all P<0.05). In the number of elderly RR-TB patients, the central urban area accounted for the most (29.49%), and the city cluster of Wuling Mountain area in southeast Chongqing. There were statistical differences between different areas. In terms of region, the new area of the main city accounted for the most (29.49%), and the town of Wuling Mountain area in southeast Chongqing accounted for the lowest (12.88%), There were statistical differences between different areas (χ2=42.422, P<0.05). The treatment acceptance rate of elderly RR-TB patients registered from 2011 to 2020 was 83.52%, and the treatment success rate was only 34.59%. The main reasons for unsuccessful treatment were death (19.96%)and loss to follow(28.60%).

Conclusion

The epidemic situation of RR-TB in the elderly is serious.Initial drug resistance, treatment acceptance, standardized management should be paid special attention.

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目的

了解重庆市老年利福平耐药肺结核的流行特征及治疗转归情况，为制定防控政策提供依据。

方法

通过国家监测系统收集2011年至2022年重庆市65岁及以上老年利福平耐药肺结核患者病案信息，采用描述性流行病学方法回顾性分析老年利福平耐药患者的流行特征及治疗转归，并与全人群中的利福平耐药患者进行比较。

结果

2011—2022年重庆市累计登记65岁以上老年利福平耐药患者885例，占全人群15.27%，年平均登记率为1.81/10万，呈逐年增加趋势（，P<0.05）；以男性（80.90%）、本地户籍（75.03%）、农民（56.61%）、复治（57.18%）为主；本地户籍、农民、初治患者占比呈逐年增加趋势；主城新区占比最多（29.49%），渝东南武陵山区城镇群最低（12.88%），各区域差异有统计学意义（χ2=42.422，P<0.05）。2011—2020年登记的老年利福平耐药结核患者纳入治疗率83.52%，治疗成功率34.59%，未治疗成功原因主要为死亡（19.96%）和丢失（28.60%）。

结论

重庆市老年利福平耐药肺结核疫情形势严峻，初治耐药、治疗管理等问题需要重点关注。

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余雅，E-mail：；
汪清雅，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=6TyWC37AgUEUTlsAl2GCyA==, magXml=0HXp6g2y7h8Fc83AprV5KA==, pdfUrl=null, pdf=Smk1EJzhJ6fU55QKt9T0dw==, pdfFileSize=609415, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=A8w3W3pLoJw1uC44rqSO7w==, mapNumber=null, authorCompany=null, fund=null, authors=

张娅（1990—），女，本科，主治医师，研究方向：结核病预防与控制

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Registration of RR-TB patients in the elderly population and the whole population in Chongqing from 2011 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）人口数（万）患者登记数（例）患者登记率（1/10万）
全人群老年人群全人群老年人群全人群老年人群
20112 884.62333.416630.230.09
20122 919.00337.733950.130.15
20132 945.00341.033640.120.12
20142 970.00352.848350.280.14
20152 991.40359.27194190.650.53
20163 016.55367.11524331.740.90
20173 048.43381.97808752.651.96
20183 075.16406.547371042.402.56
20193 101.79437.359811493.163.41
20203 124.31467.408351432.673.06
20213 205.42547.968311842.593.36
20223 212.00570.216631612.062.82
合计36 493.684 902.825 7978851.591.81
), ArticleFig(id=1240746307434902356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=CN, label=表1, caption=

2011—2022年重庆市老年人群与全人群中RR-TB患者登记情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）人口数（万）患者登记数（例）患者登记率（1/10万）
全人群老年人群全人群老年人群全人群老年人群
20112 884.62333.416630.230.09
20122 919.00337.733950.130.15
20132 945.00341.033640.120.12
20142 970.00352.848350.280.14
20152 991.40359.27194190.650.53
20163 016.55367.11524331.740.90
20173 048.43381.97808752.651.96
20183 075.16406.547371042.402.56
20193 101.79437.359811493.163.41
20203 124.31467.408351432.673.06
20213 205.42547.968311842.593.36
20223 212.00570.216631612.062.82
合计36 493.684 902.825 7978851.591.81
), ArticleFig(id=1240746307539759964, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=EN, label=Table 2, caption=

Comparison of the general situation of patients with RR-TB in the elderly population and the whole population from 2011 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
一般情况全人群登记数
[n(%)]		老年人登记数
[n(%)]		χ2P值
性别29.057<0.001
男性4 192(72.31)716（80.90）
女性1 605(17.69)169（19.10）
民族8.3660.039
汉族5 325(91.86)833（94.12）
苗族244(4.20)33（3.73）
土家族218(3.76)17（1.92）
其它10(0.18)2（0.27）
户籍82.712<0.001
本地3 422(59.03)664(75.03)
流动2 375(40.97)221(24.97)
治疗分类28.764<0.001
初治1 948(33.60)379(42.82)
复治3 849(66.40)506(57.18)
合计5 797（100.00）885（100.00）
), ArticleFig(id=1240746307627840352, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=CN, label=表2, caption=

2011—2022年老年人群与全人群RR-TB患者基本情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
一般情况全人群登记数
[n(%)]		老年人登记数
[n(%)]		χ2P值
性别29.057<0.001
男性4 192(72.31)716（80.90）
女性1 605(17.69)169（19.10）
民族8.3660.039
汉族5 325(91.86)833（94.12）
苗族244(4.20)33（3.73）
土家族218(3.76)17（1.92）
其它10(0.18)2（0.27）
户籍82.712<0.001
本地3 422(59.03)664(75.03)
流动2 375(40.97)221(24.97)
治疗分类28.764<0.001
初治1 948(33.60)379(42.82)
复治3 849(66.40)506(57.18)
合计5 797（100.00）885（100.00）
), ArticleFig(id=1240746307741086564, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=EN, label=Table 3, caption=

Registration of elderly patients with RR-TB in different regions of Chongqing from 2016 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
年份中心城区主城新区渝东北三峡库区城镇群渝东南武陵山区城镇群
登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）
20161133.331339.39721.2126.06
20173546.671520.001621.33912.00
20183028.852221.154442.3187.69
20194228.194530.204328.861912.75
20203524.483927.273927.273020.98
20214423.917038.044524.462513.59
20224729.194427.334930.432113.04
合计24428.7424829.2124328.6211413.43
χ2趋5.4282.0370.0382.098
P值0.0200.1540.8450.147
), ArticleFig(id=1240746307858527080, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=CN, label=表3, caption=

2016—2022年重庆市不同区域老年RR-TB患者登记情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份中心城区主城新区渝东北三峡库区城镇群渝东南武陵山区城镇群
登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）		登记数
（例）		构成比
（%）
20161133.331339.39721.2126.06
20173546.671520.001621.33912.00
20183028.852221.154442.3187.69
20194228.194530.204328.861912.75
20203524.483927.273927.273020.98
20214423.917038.044524.462513.59
20224729.194427.334930.432113.04
合计24428.7424829.2124328.6211413.43
χ2趋5.4282.0370.0382.098
P值0.0200.1540.8450.147
), ArticleFig(id=1240746307950801777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=EN, label=Table 4, caption=

Treatment situation of elderly RR-TB patients registered in Chongqing from 2011 to 2020

, figureFileSmall=null, figureFileBig=null, tableContent=
分类患者数[n（%）]χ2P值
未纳入治疗纳入治疗合计
性别4.4570.035
男性80(18.06)363(81.94)443（100）
女性9(9.28)88（90.72）97（100）
民族2.9730.085
汉族80（15.78）427（84.22）507（100）
少数民族9（27.27）24（72.73）33（100）
区域11.2330.011
中心城区16(9.88)146(90.12)162(100)
主城新区22(14.97)125(85.03)147(100)
渝东北三峡库区城镇群34(20.86)129(79.03)163(100)
渝东南武陵山区城镇群17(25.00)51(75.00)68(100)
职业27.141<0.010
农牧民65（23.81）208（76.19）273(100)
家务及待业7（5.51）120（94.49）127(100)
离退休10（9.09）100（90.91）110(100)
其它7（23.33）23（76.67）30(100)
户籍38.688<0.010
本地85（23.42）278（76.58）363(100)
流动4（2.26）173（97.74）177(100)
既往抗结核史6.9000.009
有29（24.37）90（75.63）119(100)
无60（14.25）361（85.75）421(100)
治疗分类3.5370.060
初治42（20.29）165（79.71）207(100)
复治47（14.11）286（85.89）333(100)
耐药类别
RMR-TB53（18.60）232（81.40）285（100）
MDR-TB36（14.46）213（85.54）249（100）2.8500.240
XDR-TB0(0.00)6（100.00）6（100）
), ArticleFig(id=1240746308055659377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=CN, label=表4, caption=

2011—2020年重庆市登记老年RR-TB患者纳入治疗情况

, figureFileSmall=null, figureFileBig=null, tableContent=
分类患者数[n（%）]χ2P值
未纳入治疗纳入治疗合计
性别4.4570.035
男性80(18.06)363(81.94)443（100）
女性9(9.28)88（90.72）97（100）
民族2.9730.085
汉族80（15.78）427（84.22）507（100）
少数民族9（27.27）24（72.73）33（100）
区域11.2330.011
中心城区16(9.88)146(90.12)162(100)
主城新区22(14.97)125(85.03)147(100)
渝东北三峡库区城镇群34(20.86)129(79.03)163(100)
渝东南武陵山区城镇群17(25.00)51(75.00)68(100)
职业27.141<0.010
农牧民65（23.81）208（76.19）273(100)
家务及待业7（5.51）120（94.49）127(100)
离退休10（9.09）100（90.91）110(100)
其它7（23.33）23（76.67）30(100)
户籍38.688<0.010
本地85（23.42）278（76.58）363(100)
流动4（2.26）173（97.74）177(100)
既往抗结核史6.9000.009
有29（24.37）90（75.63）119(100)
无60（14.25）361（85.75）421(100)
治疗分类3.5370.060
初治42（20.29）165（79.71）207(100)
复治47（14.11）286（85.89）333(100)
耐药类别
RMR-TB53（18.60）232（81.40）285（100）
MDR-TB36（14.46）213（85.54）249（100）2.8500.240
XDR-TB0(0.00)6（100.00）6（100）
), ArticleFig(id=1240746308135351159, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=EN, label=Table 5, caption=

Treatment outcomes of elderly RR-TB patients registered in Chongqing from 2011 to 2020

, figureFileSmall=null, figureFileBig=null, tableContent=
分类患者数[n（%）]χ2P值
治疗成功未治疗成功b合计
性别5.7040.017
男性116(31.96)247(68.04)363(100)
女性40(45.45)48(54.55)88(100)
民族0.5610.454
汉族146(31.19)281(68.81)427(100)
少数民族10(41.67)14(58.33)24(100)
区域6.0390.110
中心城区56(38.36)90(61.64)146(100)
主城新区35(28.00)90(72.00)125(100)
渝东北三峡库区城镇群42(32.56)87(67.44)129(100)
渝东南武陵山区城镇群23(45.10)28(54.90)51(100)
职业0.5460.909
农牧民74(35.58)134(64.42)208(100)
家务及待业39(32.50)81(67.50)120(100)
离退休34(34.00)66(66.00)100(100)
其它9(39.13)14(60.87)23(100)
户籍0.0560.813
本地95(34.17)183(65.83)278(100)
流动61(35.26)112(64.74)173(100)
既往抗结核史0.2790.598
有29(32.22)61(67.78)90(100)
无127(35.18)234(64.82)361(100)
治疗分类0.0490.825
初治56(33.94)109(66.06)165(100)
复治100(34.97)186(65.03)286(100)
治疗模式0.4170.518
住院治疗64(32.99)130(67.01)194(100)
门诊治疗81(36.00)144(64.00)225(100)
耐药类别
RMR-TB75(32.33)157(67.67)232(100)
MDR-TB78(36.62)135(63.38)213(100)1.5400.460
XDR-TB3(50.00)3(50.00)6(100)
), ArticleFig(id=1240746308210848634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375111598010390, language=CN, label=表5, caption=

2011—2020年重庆市登记老年RR-TB患者治疗转归情况

, figureFileSmall=null, figureFileBig=null, tableContent=
分类患者数[n（%）]χ2P值
治疗成功未治疗成功b合计
性别5.7040.017
男性116(31.96)247(68.04)363(100)
女性40(45.45)48(54.55)88(100)
民族0.5610.454
汉族146(31.19)281(68.81)427(100)
少数民族10(41.67)14(58.33)24(100)
区域6.0390.110
中心城区56(38.36)90(61.64)146(100)
主城新区35(28.00)90(72.00)125(100)
渝东北三峡库区城镇群42(32.56)87(67.44)129(100)
渝东南武陵山区城镇群23(45.10)28(54.90)51(100)
职业0.5460.909
农牧民74(35.58)134(64.42)208(100)
家务及待业39(32.50)81(67.50)120(100)
离退休34(34.00)66(66.00)100(100)
其它9(39.13)14(60.87)23(100)
户籍0.0560.813
本地95(34.17)183(65.83)278(100)
流动61(35.26)112(64.74)173(100)
既往抗结核史0.2790.598
有29(32.22)61(67.78)90(100)
无127(35.18)234(64.82)361(100)
治疗分类0.0490.825
初治56(33.94)109(66.06)165(100)
复治100(34.97)186(65.03)286(100)
治疗模式0.4170.518
住院治疗64(32.99)130(67.01)194(100)
门诊治疗81(36.00)144(64.00)225(100)
耐药类别
RMR-TB75(32.33)157(67.67)232(100)
MDR-TB78(36.62)135(63.38)213(100)1.5400.460
XDR-TB3(50.00)3(50.00)6(100)
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2011—2022年重庆市老年利福平耐药肺结核患者的流行特征及治疗转归分析
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张娅 , 张婷 , 范君 , 余雅 , 汪清雅
现代预防医学 | 疾病预防控制 2024,51(6): 1099-1104
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现代预防医学 | 疾病预防控制 2024, 51(6): 1099-1104
2011—2022年重庆市老年利福平耐药肺结核患者的流行特征及治疗转归分析
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张娅, 张婷, 范君, 余雅 , 汪清雅
作者信息
  • 重庆市结核病防治所区县科，重庆 400050

    • 张娅（1990—），女，本科，主治医师，研究方向：结核病预防与控制

通讯作者:

余雅，E-mail：；
汪清雅，E-mail：
Analyses of epidemiological characteristics and treatment outcomes of rifampicin-resistant tuberculosis in elderly patients in Chongqing, 2011-2022
Ya ZHANG, Ting ZHANG, Jun FAN, Ya YU , Qing-ya WANG
Affiliations
  • Chongqing Municipal Institute of Tuberculosis, Chongqing 400050, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202311306
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摘要
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目的

了解重庆市老年利福平耐药肺结核的流行特征及治疗转归情况，为制定防控政策提供依据。

方法

通过国家监测系统收集2011年至2022年重庆市65岁及以上老年利福平耐药肺结核患者病案信息，采用描述性流行病学方法回顾性分析老年利福平耐药患者的流行特征及治疗转归，并与全人群中的利福平耐药患者进行比较。

结果

2011—2022年重庆市累计登记65岁以上老年利福平耐药患者885例，占全人群15.27%，年平均登记率为1.81/10万，呈逐年增加趋势（，P<0.05）；以男性（80.90%）、本地户籍（75.03%）、农民（56.61%）、复治（57.18%）为主；本地户籍、农民、初治患者占比呈逐年增加趋势；主城新区占比最多（29.49%），渝东南武陵山区城镇群最低（12.88%），各区域差异有统计学意义（χ2=42.422，P<0.05）。2011—2020年登记的老年利福平耐药结核患者纳入治疗率83.52%，治疗成功率34.59%，未治疗成功原因主要为死亡（19.96%）和丢失（28.60%）。

结论

重庆市老年利福平耐药肺结核疫情形势严峻，初治耐药、治疗管理等问题需要重点关注。

老年  /  结核  /  耐药  /  转归
Objective

To investigate the epidemiological characteristics and treatment outcomes of elderly patients with rifampicin-resistant tuberculosis (RR-TB) in Chongqing, and to provide evidence for the formulation of prevention and control policies for drug-resistant tuberculosis in elderly population in Chongqing. MethodsData of RR-TB patients registered in Chongqing from 2011 to 2022 were collected through the tuberculosis surveillance module of National Health Security Information Project-Disease Prevention and Control Information System. Then, RR-TB patients over 65 years were screened. Retrospectively, descriptive epidemiological methods were used to analyze the epidemiological characteristics and treatment outcomes of elderly patients with RR-TB, and to compare them with RR-TB in the whole population.

Results

A total of 5 797 RR-TB patients were registered in Chongqing from 2011 to 2022, among which 885 were over 65 years old, accounting for 15.27%. The annual average patient registration rate of elderly RR-TB patients was 1.81/100 000, showed an increasing trend year by year.(,P<0.05). The elderly RR-TB patients were mainly male (80.90%), local population(75.03%), farmers (56.61%) and re-treatment (57.18%). The elderly RR-TB patients of local population, farmers and newly diagnosed patients increased year by year (,22.904,21.581, all P<0.05). In the number of elderly RR-TB patients, the central urban area accounted for the most (29.49%), and the city cluster of Wuling Mountain area in southeast Chongqing. There were statistical differences between different areas. In terms of region, the new area of the main city accounted for the most (29.49%), and the town of Wuling Mountain area in southeast Chongqing accounted for the lowest (12.88%), There were statistical differences between different areas (χ2=42.422, P<0.05). The treatment acceptance rate of elderly RR-TB patients registered from 2011 to 2020 was 83.52%, and the treatment success rate was only 34.59%. The main reasons for unsuccessful treatment were death (19.96%)and loss to follow(28.60%).

Conclusion

The epidemic situation of RR-TB in the elderly is serious.Initial drug resistance, treatment acceptance, standardized management should be paid special attention.

Elderly people  /  Tuberculosis  /  Drug resistance  /  Treatment outcome
张娅, 张婷, 范君, 余雅, 汪清雅. 2011—2022年重庆市老年利福平耐药肺结核患者的流行特征及治疗转归分析. 现代预防医学, 2024 , 51 (6) : 1099 -1104 . DOI: 10.20043/j.cnki.MPM.202311306
Ya ZHANG, Ting ZHANG, Jun FAN, Ya YU, Qing-ya WANG. Analyses of epidemiological characteristics and treatment outcomes of rifampicin-resistant tuberculosis in elderly patients in Chongqing, 2011-2022[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1099 -1104 . DOI: 10.20043/j.cnki.MPM.202311306
正文
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我国是全球27个耐药结核病高负担国家之一[1]。老年人是结核病高发的危险人群，随着老年人口不断增加，老年肺结核患者比例也逐年上升[2]。研究显示老年肺结核患者耐药率较高[3]，使肺结核防控工作面临严峻挑战。目前老年人群患耐药肺结核病的相关研究较少，本文对2011—2022年重庆市登记的老年利福平耐药肺结核患者的流行病学特征及治疗转归进行分析，为重庆市老年耐药肺结核防控提供科学依据。
1 资料和方法
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1.1 资料来源
利福平耐药患者病案信息来源于《全民健康保障信息化工程疾病预防控制信息系统—传染病监测系统》，从系统“耐药患者管理模块”中导出2011年至2022年登记的利福平耐药肺结核患者病案，内容包含患者基本情况、诊断和治疗、转归等信息。常住人口数据来源于各年度重庆市统计年鉴（2011—2022年）。
1.2 数据整理和质量控制
2011年重庆市正式启用结核信息管理系统中的耐药筛查和登记管理模块，为确保数据的准确性，对所有利福平耐药病案信息的逻辑性进行核对，剔除部分不符合逻辑的病案（菌群鉴定为非结核分枝杆菌12条，综合药敏判定结果为敏感8条）及单耐异烟肼病案73条，获得利福平耐药病案5 797条，最后筛选出老年患者病案共计885条。按照不同登记年份、不同登记地区等进行整理，纳入分析。
根据2022年重庆市统计年鉴[4]，将全市38个区县划分为4个片区，即中心主城区（9个区）、主城新区（12个区）、渝东北三峡库区城镇群（11个区县）、渝东南武陵山城镇群（6个区县）。
1.3 相关定义
参照《结核病分类WS196-2017》[5]和《中国结核病防控工作指南（2021年版）》[6]等文献对相关指标进行定义。（1）利福平耐药肺结核（Rifampicin resistant tuberculosis，RR-TB）指结核病患者感染的结核分枝杆菌（Mycobacterium tuberculosis，MTB）经体外药物敏感性试验（DST）证实对利福平耐药；（2）单耐利福平肺结核（rifampicin mono-resistant tuberculosis，RMR-TB）指结核病患者感染的MTB经体外DST证实仅对利福平耐药；（3）耐多药肺结核（multidrug-resistant tuberculosis, MDR-TB）指结核病患者感染的MTB经体外DST证实至少同时对异烟肼和利福平耐药；（4）准广泛耐药（per-extensive drug-resistant tuberculosis, pre-XDR-TB）指符合MDR/RR-TB的定义，同时对任氟喹诺酮类药品（包括左氧氟沙星、莫西沙星）耐药的MTB引起的结核病[7]；（5）广泛耐药肺结核（extensive drug-resistant tuberculosis, XDR-TB）指符合MDR/RR-TB的定义，同时对任氟喹诺酮类药品及至少1种其他的A组药品（贝达喹啉、利奈唑胺）耐药的MTB引起的结核病[7]；（6）治愈指完成规定疗程，并且无证据显示治疗失败，而且强化期后最少连续3次痰培养阴性，每次至少间隔30天；（7）完成治疗是指完成规定的疗程，并且无证据显示治疗失败，但强化期后没有达到连续3次痰培养阴性，每次至少间隔30天：（8）纳入治疗率指接受治疗的利福平耐药患者数占同期确诊利福平耐药患者的比例；（9）治疗成功指在纳入治疗的患者中治愈和完成疗程患者。
1.4 统计学分析
采用EXCEL 2017、SPSS 21.0软件建立数据库并进行统计分析。对老年RR-TB患者的流行特征进行描述，并与全人群RR-TB患者特征进行比较，采用登记率描述各年度老年RR-TB患者的登记管理情况，采用年递降（增）率来描述RR-TB变化趋势，采用Cochran-Armitage趋势卡方检验分析各年度不同区域的患者登记变化趋势，构成比和率的比较采用卡方检验，以P<0.05为差异有统计学意义。
2 结果
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2.1 RR-TB患者的流行特征
2011—2022年重庆市累计登记RR-TB患者5 797例，其中老年RR-TB患者885例，占全人群RR-TB患者比例为15.27%。年平均登记率为1.81/10万。老年患者中，单耐利福平548例（61.92%），耐多药327例（36.95%），准广泛耐药4例（0.45%），广泛耐药6例（0.68%）。
2.1.1 时间分布
2011—2022年，老年RR-TB患者登记率呈逐年上升趋势（，P<0.05）；自2018年起，老年RR-TB患者登记率高于全人群；RR-TB患者登记率年递增率（36.77%）高于全人群（22.06%），详见表1。
2.1.2 人群分布
老年RR-TB患者中，男性716例（80.90%），女性169例（19.10%），男女性别比4.24：1；民族以汉族为主（94.12%）；户籍以本地患者最多（75.03%）；职业以农民为主（56.61%）；治疗分类以复治为主（57.18%）。重庆市从2016起，在全市所有区县开展耐药筛查和登记工作，而2011—2015年仅有极少数项目区县做零星登记，为保证数据分析科学合理，在分析各年度各构成时，仅分析2016—2022年的数据，以下各年度分析同理。2016—2022年，本地户籍、农民、初治的患者占比呈逐年增加趋势（、22.904、21.581，P值均<0.05）。与全人群比较，男性老年人群、本地户籍者及初复治患者的比例均高于全人群（χ2=29.057、82.712、28.764，P均<0.05），见表2。
2.1.3 地区分布
老年RR-TB患者登记数以主城新区占比最高（29.49%），渝东南武陵山区城镇群最低（12.88%），不同区域登记数差异有统计学意义（χ2=42.422，P<0.05）；2016—2022年，中心城区老年RR-TB患者登记数占比呈现逐年下降趋势（，P<0.05），其余地区登记数占比年度变化趋势无统计学意义，见表3。
2.2 治疗与转归
据耐药治疗标准方案及转归判定时限要求，2021年及以后登记患者部分未到转归判定时间，因此仅分析2011—2020年登记患者治疗与转归情况。该期间累计登记老年RR-TB患者540例，其中RMR-TB患者285例，MDR-TB患者249例，XDR-TB患者6例，总的纳入治疗率83.52%（451/540）。XDR-TB患者全部纳入治疗，MDR-TB和RMR-TB患者纳入治疗率分别为85.54%（213/249）和81.40%（232/285），差异无统计学意义。所有纳入治疗的患者均采取长程治疗方案，男性、本地户籍、既往有抗结核史纳入的老年RR-TB患者治疗率较低（χ2=4.457、38.688、6.9，P均<0.05），不同地区患者纳入治疗率差异有统计学意义（χ2=11.233，P<0.05）。
451例纳入治疗的老年RR-TB患者中，治愈58例、完成疗程98例，治疗成功率为34.59%，死亡90例（19.96%）、治疗失败36例（8.00%），丢失129例（28.60%），未评估40例（8.87%）。治疗成功率女性高于男性（，P<0.05），而不同民族、区域、职业、户籍类型、既往抗结核史、治疗分类和治疗模式的患者治疗成功率差异无统计学意义，详见表5。2016—2020年登记患者治疗成功率变化趋势无统计学意义（，P=0.607）。不同耐药类别的成功治疗率差异无统计学意义。
3 讨论
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本研究发现，重庆市2011—2022年累计登记老年RR-TB患者885例，年平均登记率为1.81/10万，且登记率逐年增高，可能与近年来重庆市进一步加强了耐药结核病的防治工作有关。近年来，重庆市制定了全面和详细的耐药筛查方案，要求对所有登记的病原学阳性肺结核患者开展耐药筛查，并在2020年为全市各区县配备了溶解曲线或Gene-Xpert分子耐药检测设备，免费提供筛查试剂，极大提高重庆市利福平耐药患者筛查力度和检测能力，促使更多老年耐药患者被发现[8]。本研究显示，重庆市老年RR-TB患者占全人群比例逐年增高，年递增率及2022年登记率均高于全人群，提示可能原因一是近年来人口老龄化加剧，老年人口占全人口比例逐年增大，增加了人群基数[3]；二是部分未纳入治疗的RR-TB患者可能成为社区中持续的传染源，而老年人由于身体机能减弱，更易被传染，导致疫情有所上升，三是近年来重庆市不断规范和完善患者登记质量，发现的患者绝大部分被监测系统所捕获。由此可见老年RR-TB疫情形势严峻，需要重点关注并加大防控力度。
从老年RR-TB患者流行特征上看，治疗分类以复治为主，说明复治患者仍然是耐药肺结核的高危人群，发生耐药的风险较高[9]，但初治占比逐年增高，初治患者耐药率高低是反映一段时间内结核病控制效能的流行病学指标[10]，其升高除了筛查策略的影响，也可能是原发性耐药比例增大，提示应加强对耐药患者的治疗和管理[11]，减少耐药肺结核的传播。职业上以农民为主，与我市老年肺结核患者职业分布一致，较多患者分布在主城新区，与重庆市耐药肺结核患者分布一致[12]，可能与主城新区的区县数量较多，为1小时经济圈区县，且均为人口大县，老年人口基数比例较大有关。
在患者治疗转归方面，2011—2020年登记并开始治疗的老年RR-TB患者中，纳入治疗率和治疗成功率远低于全人群RR-TB患者，既往有抗结核史、渝东北三峡库区城镇群和渝东南武陵山区城镇群以及职业为农民的老年RR-TB患者纳入治疗率更低，提示可能受经济条件、地域因素和交通不便等条件制约。老年利福平耐药肺结核治疗成功率仅34.59%，明显低于安徽[13]，在治疗不良结局中死亡和丢失占比较大，可能与老年患者自身抵抗力较弱，常患有慢支炎、肺气肿等多种呼吸道疾病，肺部功能较差，且易发生并发症，加大了疾病治疗难度，并且肺结核治疗疗程较长、直接医疗费用较高[14]，患者坚持完成全疗程的主观意识弱，容易出现中断治疗或病情加重患者死亡。尚有8.87%的患者转归缺失，提示目前重庆市老年利福平耐药患者随访管理工作还有待进一步加强。
综上所述，研究者认为重庆市老年利福平耐药疫情形势严峻，治疗成功率较低，应重点关注老年农村及男性利福平耐药患者；加大对渝东北三峡库区城镇群、渝东南武陵山区城镇群等地区老年RR-TB患者的关注和防控力度，按照基本公共卫生服务项目落实耐药患者健康管理；有条件的地区可积极争取将老年RR-TB患者纳入医疗救助对象，适当给予政策倾斜。加强老年患者健康教育宣传，尤其是不规则治疗的危害，提高患者治疗依从性，从而提高治疗成功率，减少传染源；同时也要加强基于社区的健康人群个人防护宣传，进一步提高老年人群健康素养，了解肺结核核心知识，做好防护，减少被感染的几率。从有效控制传染源和保护易感人群着手，努力降低全市老年利福平耐药肺结核结核疫情。
基金
收起
  • 重庆市首批公共卫生重点学科（专科）(2022)
  • 重庆市科卫联合医学科研项目(2022MSXM101)
  • 重庆市科卫联合医学科研项目(2023MSXM143)
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参考文献 引证文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202311306
  • 接收时间：2023-11-16
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-11-16
基金
重庆市首批公共卫生重点学科（专科）(2022)
重庆市科卫联合医学科研项目(2022MSXM101)
重庆市科卫联合医学科研项目(2023MSXM143)
作者信息
    重庆市结核病防治所区县科，重庆 400050

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余雅，E-mail：；
汪清雅，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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