摘要
目的通过统计分析监测数据，客观地反映上海口岸输入性肺结核的现状，为修订输入性传染性肺结核的卫生检疫策略提供依据。方法从上海国际旅行卫生保健信息管理系统中收集2009年1月至2015年12月由上海口岸入境的居住1年及以上接受传染病监测的外籍人口329922名作为监测对象，采集494例影像学检查异常和（或）有肺结核可疑症状者连续3d晨痰，经痰涂片、痰培养后，对分离出的抗酸杆菌进行菌种鉴定，对鉴定为结核分枝杆菌复合群（Mycobacterium tuberculosis complex，MTBC）的菌种进行5种一线抗结核药物[链霉素（Sm）、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、吡嗪酰胺（PZA）]的药物敏感性试验（简称“药敏试验”）。采用SPSS16．0统计软件进行数据的统计分析，对疑诊为活动性肺结核患者的报告率、MTBC培养阳性率、MTBC对5种一线抗结核药物耐药率的比较采用χ^2检验，以P〈0．05为差异有统计学意义。结果2009年1月至2015年12月上海口岸入境监测的外籍人口中，疑诊为活动性肺结核患者共计494例，报告率为150／10万（494／329922）；经细菌学检测，MTBC培养阳性率为27／10万（88／329922），均低于我国第五次肺结核流行病学调查相关数据水平（459／10万，119／10万）。但本研究疑诊为活动性肺结核患者的报告率和MTBC培养阳性率呈逐年（2009-2015年）上升的趋势，升幅分别为（184％，40％）。耐多药肺结核（muhidrug-resistant pulmonary tuberculosis，MDR-TB）占8．5％（7／82），与我国第五次肺结核流行病学调查数据（6．8％）基本相符，差异无统计学意义（χ^21.101，P=0．294）；耐药顺位为INH（20．7％，17／82）、Sm（18．3％，15／82）、PZA（15．9％，13／82）、EMB（11．0％，9／82）、RFP（8．5％，7／82），我国第五次肺结核流行病学抽样调查的耐药率顺位为INH（28．6％）、Sin（19．6％）、RFP（8．9％）、EMB（6．8％）、PZA（-）。MTBC对各类抗结核药物耐药率比较，差异无统计学意义（XINH^2=1．987，P=0．159；XSm^2=0.074，P=0．785；XRFP^2=0．012，P=0．912；XEMB^2=1．560，P=0．212）。结论2009年1月至2015年12月上海口岸输入性疑似肺结核患者报告率、MTBC培养阳性率呈上升趋势。输入性结核病的耐药水平接近我国第五次结核病流行病学调查水平。
Objective To analyze the data of sputum examination for Chinese Visa Applicants at Shanghai port, helping to provide the objective data of foreign applicants with tuberculosis for Chinese tuberculosis surveil- lance system. Methods Morning sputum specimens of 494 cases of 329 922 foreign applicants entrying by Shang- hai port between January 2009 and December 2015 were collected for 3 consecutive days for acid-fast smear and cul- ture of Mycobacterium tuberculosis. All of them were going to live in Shanghai over 1 year, and with suspicious active tuberculosis performance on chest X-ray and/or other symptoms. The isolated Mycobacterium tuberculosis complex （MTBC） strains were subjected for drug susceptibility testing （streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide）. χ^2 test was used to analyze suspicious active tuberculosis incidence rate, MTBC positive rate and to- tal MTBC resistant rate by SPSS 16.0 software, P〈0.05 was considered statistically significant. Results Of thesample, 494 applicants were with suspicious active tuberculosis, the report rate was 150/100 000 （494/329 922）; and MTBC positive rate was 27/100 000 （88/329 922）, both the above two rates were lower than those of the 5th epidemiological survey of pulmonary tuberculosis in China （459/100 000, 119/100 000）. Suspicious active tuberculo- sis incidence rate and MTBC positive rate of foreign applicants showed their rising trends annually, which were 184% and 40% respectively. Compared to data of the 5th epidemiological survey of pulmonary tuberculosis in Chi- na, multi-drug-resistant tuberculosis （MDR-TB） rate of foreign applicants, which was 8.5% （7/82）, showed no significant difference （6.8~ vs. 8.5 %, χ^2= 1. 101,P=0. 294）; so was the order of drug resistant rate （isoniazid, 20.70../00 vs. 28.6%, streptomycin 18.3% vs. 19.6%, pyrazinamide 15.9% vs. （--）, ethambutol 11.0% vs. 2 -- 6.8%, rifampin 8. 5% vs. 8.9%） and drug resistant rates of anti-tuberculosis drugs （χ^2 INH =1. 987, P= 0. 159; χ^2=0.074, P=0.785; χ^2 RFP=0.012, P=0.912; χ^2B=1.560, P=0.212）. Conclusion Suspicious active tu- berculosis incidence rate and MTBC positive rate of foreign applicants were rising between January 2009 and Decem- ber 2015. Drug-resistant tuberculosis rate of foreign applicants in Shanghai was close to that of the 5th epidemiologi- cal survey of pulmonary tuberculosis in China.
出处
《结核病与肺部健康杂志》
2016年第3期222-226,共5页
Journal of Tuberculosis and Lung Health
基金
上海出入境检验检疫局科技计划(HK033-2014)
关键词
结核
肺
分枝杆菌
结核
人群监测
数据说明
统计
Tuberculosis, pulmonary
Mycobacterium tuberculosis
Population surveillance
Interpreta-tion, statistical
