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Article(id=1322609167869784880, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506399, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750694400000, receivedDateStr=2025-06-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793264198509, onlineDateStr=2026-10-29, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793264198509, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793264198509, creator=13701087609, updateTime=1793264198509, updator=13701087609, issue=Issue{id=1322609030938346427, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793264165863, creator='13701087609', updateTime=1793264299902, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609593264489401, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609593264489402, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4181, endPage=4187, ext={EN=ArticleExt(id=1322609168192746289, articleId=1322609167869784880, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends analysis of neonatal tuberculosis disease burden, China,1990-2021, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trends in incidence and disability-adjusted life years（DALYs）of neonatal tuberculosis in China from 1990 to 2021.

Methods

Based on the 2021 global burden of disease（GBD）study data, extracted incidence and DALYs of neonatal tuberculosis（infants aged <28 days）in China from 1990 to 2021. Using Joinpoint log-linear regression models, calculated the estimated annual percentage change（EAPC）, average annual percent change（APC）and annual percentage change（APC）by period to analyze trend variations across different drug-resistant tuberculosis types（drug-susceptible tuberculosis（DS-TB）, multidrug-resistant TB without extensive drug resistance（MDR-TB non-XDR）, and extensively drug-resistant tuberculosis（XDR-TB））.

Results

China’s exhibited a pronounced downward trend in both incidence and DALYs of neonatal tuberculosis（incidence EAPC: -5.88%, AAPC: -4.74%; DALYs EAPC: -6.36%, AAPC: -5.23%）from 1990 to 2021. The most substantial decline occurred during 2000-2010（DALYs 2000-2003 APC: -17.65%）, but significantly slowed after 2015（DALYs 2015-2021 APC: -1.96%, P=0.229）. DS-TB incidence（AAPC: -4.72%）and DALYs（AAPC: -2.60%）similarly declined, mirroring overall epidemic patterns. A precipitous decline was observed in MDR-TB non-XDR（DALYs EAPC: -8.51%）.

Conclusion

Significant achievements have been made in neonatal tuberculosis control in China over the past three decades, with particularly notable reductions in the burden of DS-TB. However, the pace of tuberculosis control progress has slowed since 2013 amid escalating threats drug-resistant tuberculosis. Critical next steps include: intensified perinatal TB screening, advanced drug-resistance surveillance, molecular diagnostics deployment, and precision interventions for sustained neonatal TB burden reduction.

, authors=Qiu-ling HUANG, Fu-xing HONG, Jian-feng HUANG, authorsList=Qiu-ling HUANG, Fu-xing HONG, Jian-feng HUANG, authorCompany=null, correspAuthors=Jian-feng HUANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322609170679968564, articleId=1322609167869784880, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2021年中国新生儿结核病负担变化趋势分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2021年中国新生儿结核病发病率与伤残调整寿命年（DALYs）变化趋势。

方法

基于全球疾病负担（GBD）2021研究数据，提取1990—2021年中国新生儿结核病（出生<28天）发病率和DALYs资料，采用Joinpoint对数线性回归模型计算估计年变化百分比（EAPC）、年度变化百分比（APC）、平均年度变化百分比（AAPC），展示不同耐药类型结核（药物敏感型〔DS-TB〕、非广泛耐药型多耐药结核病〔MDR-TB non-XDR〕、广泛耐药结核〔XDR-TB〕）的变化趋势。

结果

1990—2021年，中国新生儿结核病发病率和DALYs均显著下降（发病率EAPC为-5.88%，AAPC为-4.74%；DALYs 的EAPC为-6.36%，AAPC为-5.23%），其中2000—2010年下降最快（2000—2003年达峰值，DALYs 的APC为-17.65%），2015年后显著趋缓（DALYs 2015—2021年APC为-1.96%，P=0.229）。DS-TB发病率和DALYs亦呈下降趋势（发病率AAPC为-4.72%，DALYS的AAPC为-2.60%），阶段趋势与总体一致。MDR-TB non-XDR显著下降（DALYs 的EAPC为-8.51%）。

结论

近30年中国新生儿结核病防控成效显著，DS-TB负担持续下降。然而2013年后防控进程放缓，耐药结核病威胁持续升级。建议强化孕期和围产期结核病筛查与管理，完善耐药结核病监测体系，推广分子诊断技术，实施精准化防控策略，减轻新生儿结核病疾病负担。

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黄秋玲（1991—），女，本科，主管医师，研究方向：传染性疾病控制

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黄剑锋，E-mail:
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Module 3: diagnosis-rapid diagnostics for tuberculosis detection”（3rd edition）, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322609170906460981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, xref=null, ext=[AuthorCompanyExt(id=1322609170923238198, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, companyId=1322609170906460981, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Nanan Center for Disease Control and Prevention（Nanan Health Supervision Institute）, Nanan, Fujian 362300, China), AuthorCompanyExt(id=1322609170931626807, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, companyId=1322609170906460981, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南安市疾病预防控制中心（南安市卫生健康监督所），福建　南安　362300)])], figs=[ArticleFig(id=1322609172672262994, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=EN, label=Fig.1, caption=Incidence and DALYs of neonatal tuberculosis subtypes in china by APC , 1990-2021, figureFileSmall=cM5CCffZm1wTUYc5o9KY6A==, figureFileBig=fsTS8jKEJIifmxeOGG28fQ==, tableContent=null), ArticleFig(id=1322609172739371860, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=CN, label=图1, caption=中国不同类型新生儿结核病（1990—2021年）发病率及DALYs的年度变化百分比

注：A、B、C分别为1990—2021年间中国新生儿结核病、药物敏感结核病、非广泛耐药性耐多药结核病发病率的年度变化百分比4、E、F分别为1990—2021年间中国新生儿结核病、药物敏感结核病、非广泛耐药性耐多药结核病DALYs的年度变化百分比。

, figureFileSmall=cM5CCffZm1wTUYc5o9KY6A==, figureFileBig=fsTS8jKEJIifmxeOGG28fQ==, tableContent=null), ArticleFig(id=1322609173129442134, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=EN, label=Table 1, caption=

Incidence trends of neonatal tuberculosis subtypes in china,1990-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称1990年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB104.91（73.87~138.12）111.65（76.17~151.29）108.04（75.22~144.79）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB101.69（72.18~135.04）108.21（74.12~147.48）104.72（72.80~141.17）
MDR-TB non-XDR3.22（0.77~8.99）3.43（0.79~9.93）3.32（0.79~9.38）
TB20.95（16.22~26.14）23.01（17.56~29.06）21.90（16.80~27.42）
XDR-TB0.08（0.01~0.24）0.08（0.01~0.26）0.08（0.01~0.25）
DS-TB20.00（14.89~25.32）21.98（16.08~28.01）20.92（15.33~ 6.51）
MDR-TB non-XDR0.87（0.14~2.72）0.95（0.15~2.94）0.90（0.15~2.82）
病因名称1990—2021年
EAPCs（95% CI）（%）PC（95% CI）（%）
TB-5.88（-6.41~-5.35）-79.73（-81.96~-76.63）
XDR-TB0.03（-2.12~2.22）0.00（0.00~0.00）
DS-TB-5.69（-6.19~-5.19）-80.03（-82.77~-76.57）
MDR-TB non-XDR-8.61（-10.04~-7.17）-72.75（-96.62~39.55）
), ArticleFig(id=1322609173204939607, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=CN, label=表1, caption=

中国不同类型新生儿结核病（1990—2021年）的发病率及变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称1990年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB104.91（73.87~138.12）111.65（76.17~151.29）108.04（75.22~144.79）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB101.69（72.18~135.04）108.21（74.12~147.48）104.72（72.80~141.17）
MDR-TB non-XDR3.22（0.77~8.99）3.43（0.79~9.93）3.32（0.79~9.38）
TB20.95（16.22~26.14）23.01（17.56~29.06）21.90（16.80~27.42）
XDR-TB0.08（0.01~0.24）0.08（0.01~0.26）0.08（0.01~0.25）
DS-TB20.00（14.89~25.32）21.98（16.08~28.01）20.92（15.33~ 6.51）
MDR-TB non-XDR0.87（0.14~2.72）0.95（0.15~2.94）0.90（0.15~2.82）
病因名称1990—2021年
EAPCs（95% CI）（%）PC（95% CI）（%）
TB-5.88（-6.41~-5.35）-79.73（-81.96~-76.63）
XDR-TB0.03（-2.12~2.22）0.00（0.00~0.00）
DS-TB-5.69（-6.19~-5.19）-80.03（-82.77~-76.57）
MDR-TB non-XDR-8.61（-10.04~-7.17）-72.75（-96.62~39.55）
), ArticleFig(id=1322609175121736536, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=EN, label=Table 2, caption=

DALYs trends of neonatal tuberculosis subtypes in china ,1990-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称1990年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB1.30（0.78~1.93）1.38（0.77~2.16）1.34（0.78~2.02）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB1.26（0.77~1.88）1.35（0.75~2.07）1.30（0.77~1.94）
MDR-TB non-XDR0.03（0.01~0.10）0.04（0.01~0.10）0.04（0.01~0.10）
病因名称2021年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB0.22（0.13~0.33）0.24（0.15~0.36）0.23（0.14~0.34）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB0.21（0.12~0.31）0.23（0.14~0.35）0.22（0.13~0.33）
MDR-TB non-XDR0.01（0.00~0.03）0.01（0.00~0.03）0.01（0.00~0.03）
病因名称1990—2021年
EAPCs（95% CI）（%）PC（95% CI）（%）
TB-6.36（-6.89~-5.81）-82.94（-85.20~-80.14）
XDR-TB0.13（-2.01~2.33）/
DS-TB-6.21（-6.73~-5.69）-83.26（-86.01~-80.00）
MDR-TB non-XDR-8.51（-9.92~-7.08）-73.16（-96.51~33.84）
), ArticleFig(id=1322609175247565657, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=CN, label=表2, caption=

中国不同类型新生儿结核病（1990—2021年）的DALYs及变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称1990年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB1.30（0.78~1.93）1.38（0.77~2.16）1.34（0.78~2.02）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB1.26（0.77~1.88）1.35（0.75~2.07）1.30（0.77~1.94）
MDR-TB non-XDR0.03（0.01~0.10）0.04（0.01~0.10）0.04（0.01~0.10）
病因名称2021年
男（95% UI）（/10万）女（95% UI）（/10万）总（95% UI）（/10万）
TB0.22（0.13~0.33）0.24（0.15~0.36）0.23（0.14~0.34）
XDR-TB0.00（0.00~0.00）0.00（0.00~0.00）0.00（0.00~0.00）
DS-TB0.21（0.12~0.31）0.23（0.14~0.35）0.22（0.13~0.33）
MDR-TB non-XDR0.01（0.00~0.03）0.01（0.00~0.03）0.01（0.00~0.03）
病因名称1990—2021年
EAPCs（95% CI）（%）PC（95% CI）（%）
TB-6.36（-6.89~-5.81）-82.94（-85.20~-80.14）
XDR-TB0.13（-2.01~2.33）/
DS-TB-6.21（-6.73~-5.69）-83.26（-86.01~-80.00）
MDR-TB non-XDR-8.51（-9.92~-7.08）-73.16（-96.51~33.84）
), ArticleFig(id=1322609175541166938, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=EN, label=Table 3, caption=

Joinpoint regression analysis of neonatal tuberculosis incidence by subtype in china, 1990-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称指标区间段（年）变化值（%）95% CI（%）P值
TBAPC1990—2000-2.34-3.42~-1.24<0.001
2000—2003-16.80-23.41~-9.62<0.001
2003—2015-4.71-5.64~-3.78<0.001
2015—2021-1.38-4.10~1.420.331
AAPC1990—2021-4.74-5.86~-3.63<0.001
MDR-TB non-XDRAPC1990—199253.5637.32~71.72<0.001
1992—19980.85-2.90~4.730.662
1998—2014-13.75-14.48~-13.00<0.001
2014—20210.99-1.99~4.050.520
AAPC1990—2021-2.54-4.34~-0.730.006
DS-TBAPC1990—2000-3.06-4.13~-1.96<0.001
2000—2003-16.42-23.00~-9.29<0.001
2003—2015-4.17-5.09~-3.23<0.001
2015—2021-1.40-4.10~1.370.318
AAPC1990—2021-4.72-5.79~-3.65<0.001
), ArticleFig(id=1322609175612470107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=CN, label=表3, caption=

1990—2021年中国不同类型新生儿结核病发病率的Joinpoint回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称指标区间段（年）变化值（%）95% CI（%）P值
TBAPC1990—2000-2.34-3.42~-1.24<0.001
2000—2003-16.80-23.41~-9.62<0.001
2003—2015-4.71-5.64~-3.78<0.001
2015—2021-1.38-4.10~1.420.331
AAPC1990—2021-4.74-5.86~-3.63<0.001
MDR-TB non-XDRAPC1990—199253.5637.32~71.72<0.001
1992—19980.85-2.90~4.730.662
1998—2014-13.75-14.48~-13.00<0.001
2014—20210.99-1.99~4.050.520
AAPC1990—2021-2.54-4.34~-0.730.006
DS-TBAPC1990—2000-3.06-4.13~-1.96<0.001
2000—2003-16.42-23.00~-9.29<0.001
2003—2015-4.17-5.09~-3.23<0.001
2015—2021-1.40-4.10~1.370.318
AAPC1990—2021-4.72-5.79~-3.65<0.001
), ArticleFig(id=1322609175960597340, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=EN, label=Table 4, caption=

Joinpoint regression analysis of neonatal tuberculosis DALYs by subtype in china, 1990-2021

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称指标区间段（年）变化值（%）95% CI（%）P值
TBAPC1990—2000-2.74-3.98~-1.48<0.001
2000—2003-17.65-25.16~-9.40<0.001
2003—2015-4.99-6.05~-3.91<0.001
2015—2021-1.96-5.08~1.260.229
AAPC1990—2021 -5.23-6.48~-3.98<0.001
MDR-TB non-XDRAPC1990—199253.0134.43~74.15<0.001
1992—19972.77-3.01~8.900.355
1997—2014-13.22-14.00~-12.43<0.001
2014—20210.52-2.90~4.060.768
AAPC1990—2021-2.60-4.73~-0.460.017
DS-TBAPC1990—2000-3.41-4.64~-2.17<0.001
2000—2003-17.61-25.06~-9.42<0.001
2003—2015-4.57-5.63~-3.49<0.001
2015—2021-2.15-5.24 ~1.030.183
AAPC1990—2021-5.24-6.44~-4.04<0.001
), ArticleFig(id=1322609176380027741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, language=CN, label=表4, caption=

1990—2021年中国不同类型新生儿结核病DALYs的Joinpoint回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
病因名称指标区间段（年）变化值（%）95% CI（%）P值
TBAPC1990—2000-2.74-3.98~-1.48<0.001
2000—2003-17.65-25.16~-9.40<0.001
2003—2015-4.99-6.05~-3.91<0.001
2015—2021-1.96-5.08~1.260.229
AAPC1990—2021 -5.23-6.48~-3.98<0.001
MDR-TB non-XDRAPC1990—199253.0134.43~74.15<0.001
1992—19972.77-3.01~8.900.355
1997—2014-13.22-14.00~-12.43<0.001
2014—20210.52-2.90~4.060.768
AAPC1990—2021-2.60-4.73~-0.460.017
DS-TBAPC1990—2000-3.41-4.64~-2.17<0.001
2000—2003-17.61-25.06~-9.42<0.001
2003—2015-4.57-5.63~-3.49<0.001
2015—2021-2.15-5.24 ~1.030.183
AAPC1990—2021-5.24-6.44~-4.04<0.001
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1990—2021年中国新生儿结核病负担变化趋势分析
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黄秋玲 , 洪福星 , 黄剑锋
现代预防医学 | 疾病预防控制 2025,52(22): 4181-4187
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现代预防医学 |疾病预防控制 2025 , 52 (22) : 4181 -4187
1990—2021年中国新生儿结核病负担变化趋势分析
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[Author(id=1322609171011318585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322609171086816059, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, authorId=1322609171011318585, language=EN, stringName=Qiu-ling HUANG, firstName=Qiu-ling, middleName=null, lastName=HUANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Nanan Center for Disease Control and Prevention（Nanan Health Supervision Institute）, Nanan, Fujian 362300, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322609171153924925, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609167869784880, authorId=1322609171011318585, language=CN, stringName=黄秋玲, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=南安市疾病预防控制中心（南安市卫生健康监督所），福建　南安　362300, bio={"content":"

黄秋玲（1991—），女，本科，主管医师，研究方向：传染性疾病控制

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黄秋玲（1991—），女，本科，主管医师，研究方向：传染性疾病控制

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黄秋玲, 洪福星, 黄剑锋
作者信息
  • 南安市疾病预防控制中心（南安市卫生健康监督所），福建　南安　362300
通讯作者:
黄剑锋，E-mail:
作者简介:

黄秋玲（1991—），女，本科，主管医师，研究方向：传染性疾病控制

Trends analysis of neonatal tuberculosis disease burden, China,1990-2021
Qiu-ling HUANG, Fu-xing HONG, Jian-feng HUANG
Affiliations
  • Nanan Center for Disease Control and Prevention（Nanan Health Supervision Institute）, Nanan, Fujian 362300, China
出版时间: 2025-11-25 doi: 10.20043/j.cnki.MPM.202506399
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摘要
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目的

分析1990—2021年中国新生儿结核病发病率与伤残调整寿命年（DALYs）变化趋势。

方法

基于全球疾病负担（GBD）2021研究数据，提取1990—2021年中国新生儿结核病（出生<28天）发病率和DALYs资料，采用Joinpoint对数线性回归模型计算估计年变化百分比（EAPC）、年度变化百分比（APC）、平均年度变化百分比（AAPC），展示不同耐药类型结核（药物敏感型〔DS-TB〕、非广泛耐药型多耐药结核病〔MDR-TB non-XDR〕、广泛耐药结核〔XDR-TB〕）的变化趋势。

结果

1990—2021年，中国新生儿结核病发病率和DALYs均显著下降（发病率EAPC为-5.88%，AAPC为-4.74%；DALYs 的EAPC为-6.36%，AAPC为-5.23%），其中2000—2010年下降最快（2000—2003年达峰值，DALYs 的APC为-17.65%），2015年后显著趋缓（DALYs 2015—2021年APC为-1.96%，P=0.229）。DS-TB发病率和DALYs亦呈下降趋势（发病率AAPC为-4.72%，DALYS的AAPC为-2.60%），阶段趋势与总体一致。MDR-TB non-XDR显著下降（DALYs 的EAPC为-8.51%）。

结论

近30年中国新生儿结核病防控成效显著，DS-TB负担持续下降。然而2013年后防控进程放缓，耐药结核病威胁持续升级。建议强化孕期和围产期结核病筛查与管理，完善耐药结核病监测体系，推广分子诊断技术，实施精准化防控策略，减轻新生儿结核病疾病负担。

新生儿  /  结核病  /  发病率  /  伤残调整寿命年  /  全球疾病负担
Objective

To analyze the trends in incidence and disability-adjusted life years（DALYs）of neonatal tuberculosis in China from 1990 to 2021.

Methods

Based on the 2021 global burden of disease（GBD）study data, extracted incidence and DALYs of neonatal tuberculosis（infants aged <28 days）in China from 1990 to 2021. Using Joinpoint log-linear regression models, calculated the estimated annual percentage change（EAPC）, average annual percent change（APC）and annual percentage change（APC）by period to analyze trend variations across different drug-resistant tuberculosis types（drug-susceptible tuberculosis（DS-TB）, multidrug-resistant TB without extensive drug resistance（MDR-TB non-XDR）, and extensively drug-resistant tuberculosis（XDR-TB））.

Results

China’s exhibited a pronounced downward trend in both incidence and DALYs of neonatal tuberculosis（incidence EAPC: -5.88%, AAPC: -4.74%; DALYs EAPC: -6.36%, AAPC: -5.23%）from 1990 to 2021. The most substantial decline occurred during 2000-2010（DALYs 2000-2003 APC: -17.65%）, but significantly slowed after 2015（DALYs 2015-2021 APC: -1.96%, P=0.229）. DS-TB incidence（AAPC: -4.72%）and DALYs（AAPC: -2.60%）similarly declined, mirroring overall epidemic patterns. A precipitous decline was observed in MDR-TB non-XDR（DALYs EAPC: -8.51%）.

Conclusion

Significant achievements have been made in neonatal tuberculosis control in China over the past three decades, with particularly notable reductions in the burden of DS-TB. However, the pace of tuberculosis control progress has slowed since 2013 amid escalating threats drug-resistant tuberculosis. Critical next steps include: intensified perinatal TB screening, advanced drug-resistance surveillance, molecular diagnostics deployment, and precision interventions for sustained neonatal TB burden reduction.

Neonate  /  Tuberculosis  /  Incidence  /  Disability-adjusted life years  /  Global burden of disease
黄秋玲, 洪福星, 黄剑锋. 1990—2021年中国新生儿结核病负担变化趋势分析. 现代预防医学, 2025 , 52 (22) : 4181 -4187 . DOI: 10.20043/j.cnki.MPM.202506399
Qiu-ling HUANG, Fu-xing HONG, Jian-feng HUANG. Trends analysis of neonatal tuberculosis disease burden, China,1990-2021[J]. Modern Preventive Medicine, 2025 , 52 (22) : 4181 -4187 . DOI: 10.20043/j.cnki.MPM.202506399
正文
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结核病（Tuberculosis，TB）依然是全球最重要的传染病之一，尽管各国已长期开展防控，但其仍是主要的死亡原因[1]。仅在2021年，全球就估计有1 060万例新发结核病病例，其中约160万人死于该病，这表明全球结核病防控面临严峻挑战[1]。儿童是结核病的高危人群，2021年约有120万新发儿童结核病例，其中22万例因结核病死亡[1]。新生儿和婴幼儿由于免疫功能尚未成熟，暴露于结核分枝杆菌（Mycobacterium tuberculosis， MTB）更易感染。在免疫功能正常的人群中，婴幼儿感染MTB后进展为结核病（含播散性结核病）的发病风险最高，其病原学诊断困难，MTB培养阳性率只有30%~40%[2]。新生儿结核病临床表现无特异性，极易被误诊误治，有统计发现未经抗结核治疗的新生儿结核病，2月内死亡率高达40%~100%，早诊早治预后可改善[3]。这一现状凸显了新生儿结核病在公共卫生领域的重要性。
新生儿结核病临床上可表现为药物敏感结核病（Drug-Susceptible Tuberculosis，DS-TB），也可能是更为严峻的耐药结核。耐多药结核病（Multidrug-Resistant Tuberculosis，MDR-TB）指至少对异烟肼和利福平耐药的结核，广泛耐药结核病（Extensively Drug-Resistant Tuberculosis，XDR-TB）则在MDR基础上对任意氟喹诺酮及二线注射剂耐药[4]。新生儿结核病以DS-TB最为常见，可通过一线药物治疗，但MDR-TB和XDR-TB的出现给新生儿防治带来巨大挑战。MDR-TB在新生儿中的治疗选择有限，疗程长，药物毒性大，治疗效果不佳，经济负担沉重[5]。尽管XDR-TB在新生儿中尚属罕见，但一旦发生几乎无有效治疗方案，预后极差[4]。当前全球儿童结核中约13.6%存在不同程度的耐药现象，这进一步加剧了新生儿结核病防控的难度[5]。
中国在新生儿结核病防控方面取得了显著成效。国家结核病防治计划的制定、直接观察下短程化疗（Directly Observed Treatment,Short-Course，DOTS）策略推广、免费抗结核药品政策实施和快速分子诊断技术推广等一系列强有力的防治措施，大幅度降低了结核病疾病负担[6]。普及的新生儿卡介苗（Bacillus Calmette-Guérin vaccine，BCG）接种对结核性脑膜炎与粟粒性结核病有大于3%的保护效果，对肺结核有70%左右的保护作用[7]，但中国结核病防控仍面临挑战。疫情干扰、医疗资源不均等因素使农村和贫困地区结核病防控相对滞后[8]。MDR-TB等耐药结核的管理难题也亟待解决[8]。既往研究极少聚焦新生儿或细化至DS-TB、MDR-TB、XDR-TB等分型[9]，阻碍了深入理解新生儿结核病防控成效及不同类型结核病负担的演变情况。在此背景下，本研究基于1990—2021年全球疾病负担（Global Burden of Disease GBD）数据，系统分析中国新生儿结核病不同分型的发病率和伤残调整寿命年（Disability-Adjusted Life Years，DALYs）趋势，为公共卫生决策提供数据支撑。
1　资料与方法
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1.1　数据来源
本研究基于2021年GBD研究公开数据，来源于全球健康数据交换平台（GHDx）（http://ghdx.healthdata.org/gbd-results-tool）[10]。GBD研究对1990—2021年间204个国家和地区350余种疾病与伤害提供标准化发病率、死亡率及DALYs估计值[10]。
1.2　病例定义
研究对象为GBD数据库中报告的新生儿（出生<28天）结核病病例[4]。按耐药类型分为：
药物敏感结核病（DS-TB）：对异烟肼、利福平均无耐药[4]。
非广泛耐药型多耐药结核病（Multidrug-resistant tuberculosis without extensive drug resistance,MDR-TB non-XDR）：对异烟肼、利福平至少耐药，但不符合XDR标准[4]。
广泛耐药结核病（XDR-TB）：对异烟肼、利福平、任一氟喹诺酮和至少一种二线注射剂耐药[4]。
分类依据世界卫生组织（World Health Organization，WHO）标准[4]，GBD一致应用。
1.3　分析指标
本研究分析的核心指标包括：发病率（每10万活产）[10]、DALYs（每10万）[10]。
1.4　统计方法
所有数据分析和数据可视化均使用R（版本4.4.2）和JD_GBDR（版本2.37）完成。估计年变化百分比（Estimated Annual Percent Change，EAPC）的回归模型通过R中 lm（）函数实现，自定义脚本计算变化率并提取置信区间；总变化百分比（Percentage Change，PC）通过直接代入计算公式获得。图表绘制采用 ggplot2 和 matplotlib 完成，结果整理使用 dplyr 与 pandas 工具包。Joinpoint分析算法参考美国国家癌症研究所Joinpoint回归软件[11]，计算年度变化百分比（Annual Percent Change，APC）、平均年变化百分比（Average Annual Percent Change，AAPC）和总变化百分比（PC）趋势显著性通过置换检验（Permutation Test）进行评估，设定显著性水平为0.05。
2　结果
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2.1　不同类型新生儿结核病发病率的变化趋势
1990—2021年间，中国新生儿结核病总发病率显著下降（AAPC为-4.74%，95% CI：-5.86%~-3.63%，P<0.001），由1990年的108.04/10万（95% UI: 75.22%~144.79%）降至2021年的21.90/10万（95% UI: 16.80%~27.42%），EAPC为-5.88%（95% CI: -6.41%~-5.35%），PC为-79.73%（95% CI: -81.96%~-76.63%）。分段回归分析显示：1990—2000年为缓慢下降期（APC为-2.34%，P<0.001），2000—2003年下降速率显著加快（APC为-16.80%，P<0.001），2003—2015年保持稳定下降（APC为-4.71%，P<0.001），2015—2021年降幅趋缓（APC为-1.38%，P=0.331），提示近年来疫情干扰等因素可能削弱了既有防控成效。见表1、表3、图1A。
分类型来看，DS-TB发病率与总体趋势一致，AAPC为-4.72%（95% CI:-5.78%~-3.65%，P<0.001），由1990年的104.72/10万（95% UI: 72.80%~141.17%）降至2021年的20.92/10万（95% UI: 15.33%~26.51%），EAPC为-5.69%（95% CI: -6.19%~-5.19%），PC为-80.03%（95% CI: -82.77%~-76.57%）。分阶段看：1990—2000年为下降初期（APC 为-3.06%，P<0.001）；2000—2003年降幅显著扩大（APC为-16.42%，P<0.001）；2003—2015年维持稳定下降趋势（APC为-4.17%，P<0.001）；2015—2021年下降趋势不再显著（APC为-1.40%，P=0.318），提示疾病控制成效进入平台期。见表1、表3、图1B。
同期，MDR-TB non-XDR则从1990年的3.32/10万降至2021年的0.90/10万，EAPC为-8.61%（95% CI: -10.04 %~-7.17%），PC为-72.75%（95% CI: -96.62%~-39.55%），其发病率AAPC为-2.54%（95% CI:-4.34%~0.73%，P=0.006），呈显著下降趋势，1998—2014年下降幅度（APC为-13.75%，P<0.001）。XDR-TB仅在2021年有病例，估计发病率（0.08/10万）。绝大多数结核病类型在男女新生儿之间发病率差异不大，趋势方向一致。见表1、表3、图1C。
2.2　不同类型新生儿结核病DALYs的变化趋势
1990年至2021年间，中国新生儿结核病的DALY负担显著减轻（AAPC为-5.23%，95% CI:-6.48%~-3.98%，P<0.001），从1990年的1.34/10万（95% UI: 0.78%~2.02%）降至2021年的0.23/10万（95% UI: 0.14%~0.34%），下降幅度为82.94%（95% CI: -85.20%~-80.14%），EAPC为-6.36%（95% CI: -6.89%~-5.81%）。分段分析显示，1990—2000年为温和下降期（APC为-2.74%，P<0.001），2000—2003年下降幅度最大（APC为-17.65%，P<0.001），2003—2015年维持稳定下降趋势（APC为-4.99%，P<0.001），而2015—2021年下降趋势明显减缓（APC为-1.96%，P=0.229），表明结核病健康损失控制已进入平台期，提示需创新干预措施以进一步减轻负担。见表2、表4、图1D。
其中，DS-TB的DALYs由1990年的1.30/10万（95% UI: 0.77%~1.94%）降至2021年的0.22/10万（95% UI: 0.13%~0.33%），EAPC为-6.21%（95% CI: -6.73%~-5.69%），PC为-83.26%（95% CI: -86.01%~-80.00%），降幅大于发病率，健康损失缩减更显著。1990—2021年的AAPC为-5.24%（95% CI:-6.44%~-4.04%，P<0.001），分段趋势与总体高度一致：1990—2000年为稳定下降阶段（APC为-3.41%，P<0.001）；2000—2003年为下降加速期（APC为-17.61%，P<0.001）；2003—2015年持续下降（APC为-4.57%，P<0.001）；2015—2021年下降趋势趋于平稳，差异无统计学意义（APC为-2.15%，P=0.183）。见表2、表4、图1E。
MDR-TB non-XDR的DALYs从0.04/10万下降至0.01/10万，EAPC为-8.51%（95% CI:-9.92%~-7.08%），其AAPC为-2.60%（95% CI:-4.73%~-0.46%，P=0.017），呈下降趋势，最大降幅在1997—2014年（APC为-13.22%，P<0.001）。XDR-TB的DALYs的EAPC为0.13%（95% CI: -2.01~2.33）。不同类型结核病在男女新生儿中的DALYs负担基本相当，变化趋势方向一致，未见显著性别差异。见表2、表4、图1F。
3　讨论
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3.1　中国新生儿结核病负担变化四阶段及防控成效
1990—2021年，中国新生儿结核病发病率与DALYs总体呈现显著下降趋势，这一研究发现与GBD研究估算相一致，即1990—2019年中国结核病疾病负担整体呈持续下降态势，自2015年开始中国TB、MDR-TB和XDR-TB的DALYs下降速度明显放缓[12]。中国新生儿结核病负担变化可概括为四个阶段，与国家防控策略密切相关：
1990—2000年缓慢下降期：此阶段BCG接种普及（覆盖率>85%），但结核病控制体系仍不健全，母源结核传播风险高，新生儿结核病发病率下降幅度有限[13]。2000—2010年快速下降期：全国结核病防治规划和DOTS策略在全国推广，免费诊治政策落实，社区传播显著减少，新生儿结核负担急剧下降（如DALYs 2000—2003年APC高达-17.65%）[14]。2011—2015年稳定下降期：结核病防治模式转型，医疗机构主导结核病管理，GeneXpert MTB/RIF等新兴技术引入，防控成效持续但降幅趋缓[15]。2016—2021年平台期：新生儿结核病负担下降接近瓶颈，发病率和DALYs降幅减缓（如DALYs 2015—2021年APC为-1.96%，P=0.229），耐药结核、农村地区防控薄弱、人口流动等成为主要挑战[10]。
中国经验显示，高政治承诺、强有力公共卫生干预、免费诊疗和高BCG接种率是快速降低新生儿结核病负担的关键。但要进一步降低至“零负担”，需针对边缘人群和耐药结核病开展精准防控。
3.2　药物敏感型与耐药型结核病在新生儿人群中的防控成效与挑战
新生儿结核病以DS-TB为主，中国在药物敏感型结核病防控方面取得领先于全球的成效，尤其2000—2010年降幅显著高于全球平均水平[14]。然而2015年后发病率和DALYs降幅减缓，防控进展放缓。这表明传统防控措施（BCG、DOTS等）在达到一定防控水平后难以进一步快速压降负担，提示在耐药结核病防治、重点人群防控、新兴快速诊断技术推广等方面需共同努力[6]。
Sun等研究显示新生儿感染结核多数由于母亲妊娠期MTB经垂直传播，或者在母体宫内、分娩中吸入或吞入病菌引起[16]。耐药型结核病往往源于母源或密切接触者感染，但因新生儿结核病诊断困难、标本获取受限，耐药型结核病在新生儿中的真实负担可能被严重低估[17-18]。同时，MDR-TB/XDR-TB治疗毒性高、方案缺乏、疗程长，给新生儿防控带来巨大挑战，有研究发现结核患者相较于非结核患者的新生儿早产、宫内发育迟缓、低出生体重的风险提高约2倍，围产儿死亡更攀升至6倍[19]。强调需从源头防控母源结核，强化孕期和围产期筛查。
近年来，随着MDR-TB和XDR-TB的出现，耐药结核病治疗失败和死亡率均有所升高，全球对于新生儿MDR-TB相关指南、共识数据有限，且新生儿结核病临床和影像学表现无特异性，MTB检出率低，病情发展迅速，易误诊误治。岳英等[20]的研究揭示，在16例新生儿结核病例前期抗感染效果不佳后才诊断结核病，发病到诊断间隔时间3~44天，误诊率88.9%。更值得注意的是，在1例新生耐药结核病诊疗过程中，由于诊治经验不足，一线抗结核治疗方案未及时调整，导致患儿后期病情反复。这提示非专科医院辅助检查单一，敏感度及特异度不高，导致误诊率增高。在此背景下，新兴分子诊断技术如宏基因组测序（mNGS）、靶向高通量测序技术（tNGS）的发展，可显著缩短耐药结核的确诊时间，有效控制耐药菌株的传播，从而缩短病程并提高治疗成功率[21-22]，但其存在价格昂贵临床使用受限等的问题有待今后进一步研究。
3.3　局限性与未来研究方向
本研究基于GBD估算，受限于新生儿结核病特异数据缺乏、耐药型结核病估计不确定性大等局限。未来需加强以下领域研究：母婴传播机制及防控策略，包括孕期系统筛查、潜伏结核治疗研究；新生儿结核病精准监测与耐药型结核流行病学特征，推动耐药分型和基因组流行病学研究；适合新生儿的快速诊断工具与耐药结核病预防方案，提升防控精准度；创新疫苗与免疫干预研究，探索孕期疫苗或母源免疫策略。
4　结论
收起
中国新生儿结核病防控已取得重要进展，但近十年防控成效放缓，耐药结核病威胁上升，提示必须转向更精准、更系统的防控策略。保护新生儿，必须强化母婴一体化结核管理、创新诊断与防控工具，并持续推动政策与科研协同发力。

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2025年第52卷第22期
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doi: 10.20043/j.cnki.MPM.202506399
  • 接收时间：2025-06-24
  • 首发时间：2026-10-29
  • 出版时间：2025-11-25
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  • 收稿日期：2025-06-24
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    南安市疾病预防控制中心（南安市卫生健康监督所），福建　南安　362300

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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
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