CAJ | 학술논문

目的对江苏和浙江省两个农业县全年登记的结核病患者中分离获得的耐药结核分枝杆菌(结核菌)进行基因分型,描述以基因型"成簇性"为定义的耐药结核病在该地近期传播及其影响因素.方法以结核菌散在分布重复单位(MIRU)和IS6110限制性内切酶片段长度多态性(IS6110-RFLP)基因分型技术识别耐药结核菌基因型的"成簇性"和"惟一性",描述223例耐药结核病患者结核菌分离株的成簇性分布特征,识别耐药结核菌的人群间传播,分析人口学特征、社会经济水平和就医行为对耐药结核病传播的影响.结果 223株耐药结核菌株中有52株具有成簇性,形成22个簇,提示簇内患者间发生了耐药结核病的近期传播;其余171株的基因型表现为"惟一性".耐药结核菌成簇性影响因素分析显示:与18～30岁人群相比,30～60岁年龄组(30～岁/18～岁年龄组:30.9% vs.11.9%;OR=3.297,95%CI:1.169～9.297)和复治耐药结核病患者(复治/初治:32.9% vs.18.4%;OR=2.163,95%CI:1.144～4.090)所感染的结核菌更容易成簇;对异烟肼和利福平同时耐药的耐多药结核菌比仅耐一种一线抗结核药物的单耐药菌株更多地表现为成簇(47.2%vs.15.5%;OR=4.773,95%CI:2.316～9.837),耐药结核菌株的近期传播呈现以村落为单位的小范围、散发特点.结论华东农村地区人群中存在耐药结核病的近期传播,其主要传播方式可能为村落内偶然接触;耐药结核病的控制需要重点关注中年人群和复治结核病患者.
목적 대강소화절강성량개농업현전년등기적결핵병환자중분리획득적내약결핵분지간균(결핵균)진행기인분형,묘술이기인형"성족성"위정의적내약결핵병재해지근기전파급기영향인소.방법 이결핵균산재분포중복단위(MIRU)화IS6110한제성내절매편단장도다태성(IS6110-RFLP)기인분형기술식별내약결핵균기인형적"성족성"화"유일성",묘술223례내약결핵병환자결핵균분리주적성족성분포특정,식별내약결핵균적인군간전파,분석인구학특정、사회경제수평화취의행위대내약결핵병전파적영향.결과 223주내약결핵균주중유52주구유성족성,형성22개족,제시족내환자간발생료내약결핵병적근기전파;기여171주적기인형표현위"유일성".내약결핵균성족성영향인소분석현시:여18～30세인군상비,30～60세년령조(30～세/18～세년령조:30.9% vs.11.9%;OR=3.297,95%CI:1.169～9.297)화복치내약결핵병환자(복치/초치:32.9% vs.18.4%;OR=2.163,95%CI:1.144～4.090)소감염적결핵균경용역성족;대이연정화리복평동시내약적내다약결핵균비부내일충일선항결핵약물적단내약균주경다지표현위성족(47.2%vs.15.5%;OR=4.773,95%CI:2.316～9.837),내약결핵균주적근기전파정현이촌락위단위적소범위、산발특점.결론 화동농촌지구인군중존재내약결핵병적근기전파,기주요전파방식가능위촌락내우연접촉;내약결핵병적공제수요중점관주중년인군화복치결핵병환자.
Objective To investigate the contribution of recent transmission in the epidemic of drug-resistant Mycobacterium tuberculosis (M. TB) and related factors from biomedical and social-demographic perspectives in the Eastern rural areas of China. Methods Identified by proportio5n method of drug susceptibility test, 223 drug resistant M. TB isolates and their hosts were included in the present study. These drug resistant tuberculosis isolates were first genotyped by Mycobacterial Interspersed Repetitive Units(MIRU),and those isolates with identical MIRU defined as two patients' M. TB isolates harboring the identical MIRU genotype and IS6110-based RFLP pattern simultaneously. Unique strains denoted those with the unparalleled MIRU genotype in the study collection. Socio-demographic and biomedical characteristics of host patients were compared between the clusters and unique groups through univariate and multivariate logistic regression analysis. Results Based on the MIRU-IS6110 pattern, there were 52 isolates belonged to the "cluster" group and 171 as the "unique" group. Drug resistant M. TB strain isolated from patients at the age of 30-60 year had a higher probability of being clustered, comparing to those from patients below 30 years of age (30.9% vs. 11.9%;OR=3.297; 95%CI: 1.169-9.297). Such finding were also seen in the isolates from patients with previous treatment history compared to newly diagnosed patients (32.9% vs. 18.4%; OR=2.163, 95% CI: 1.144-4.090). The multi-drug resistant M. TB strain was found to have been more frequently clustered when comparing to the mono-drug resistant M. TB (47.2% vs. 15.5%; OR=4.773; 95%CI: 2.316-9.837). The transmission pattern of drug resistant tuberculosis was presented mainly by the sporadic distribution in small group within rural villages. Conclusion Transmission of drug-resistant tuberculosis was seen in the population living in the Eastern rural areas of China, and causal contact within villages was considered as the main route of recent transmission. Patients at middle age and having previous tuberculosis treatment history might have increased the risk of transmission by patients with drug resistant tuberculosis.