| Objectives:To investigate the trend of the drug-resistant rate of Mycobacterium tuberculosis(MTB)strains isolated from positive bacteriological pulmonary tuberculosis patients in Yunnan province between 2011?2013 to 2019.The trend of tuberculosis resistance,the influencing factors of tuberculosis resistance and the sequential changes of six anti-tuberculosis drugs were preliminarily obtained.The distribution of rifampicin resistant genes was analyzed.This study provided a basis for formulating the prevention and treatment intervention measures for drug-resistant tuberculosis and evaluated the effect of prevention and treatment in the past.Methods:The method of retrospective survey was conducted.The baseline survey data of drug resistance were acquired in Yunnan province from 2011,The gender,age,ethnicity,occupation,treatment classification and drug-susceptibility testing(DST)of patients with positive bacteriological pulmonary tuberculosis registered in the tuberculosis management information system(TMIS)were collected in Yunnan province from 2013 to 2019,Patients were successively admitted to analysis in the tuberculosis clinical treatment center of Yunnan center for disease control and prevention in 2018-2019.The GeneXpert rapid diagnosis technology was used to identify mycobacterium tuberculosis and detect rifampicin susceptibility and drug resistance genes from the samples of patients.Meanwhile,the gender,age and other information of the patients were collected.SPSS23.0 carried out statistical analysis,rate and composition ratio were statistically described.By means of chi-square test to analysis the trend of drug resistance rate.By means of binary logistic regression model to analysis the influencing factors of drug resistance.Results:1.A total of 28,676 patients with positive bacteriological pulmonary tuberculosis were included in this study,of which 20,873(72.8%)patients were males,The male-female ratio was 2.7 to 1.11,079(38.6%)patients were aged from 40 to 59 years.16,005(55.8%)patients were The Han nationality.Farmer were the main occupation,with 24,555(85.6%)cases.21465(74.9%)patients with initial treatment.2.Among the 4,497 patients with drug-resistance tuberculosis,of which 3,319(73.8%)patients were male,The male-female ratio was 2.8 to 1.There were 1877(41.7%)patients aged from 40 to 59 years.The Han nationality was dominant,with 2,664(59.2%)cases.Farmer were the main occupation,with 3797(84.4%)of patients.There were 2821(62.7%)cases with initial treatment.3.The drug-resistance rate in positive bacteriological pulmonary tuberculosis patients ranged from 10.3%to 37.9%(P<0.001),The drug-resistance rate in positive bacteriological pulmonary tuberculosis patients showed a decreasing trend(P<0.001).The drug-resistance rate of the initial treatment patients ranged from 7.7%to 34.1%(P<0.001),showed a decreasing trend(P<0.001).The drug-resistance rate of the retreatment patients ranged from 19.1%to 56.5%(P<0.001),showed a decreasing trend(P<0.001).4.The resistant rate of six kinds of anti-tuberculosis drugs among patients with positive bacteriological tuberculosis ranked the top three respectively as ethambutol,isoniazid and streptomycin in 2011,and the resistance rate of rifampin rose to the first place in 2018 to 2019.The resistance rate of six kinds of anti-tuberculosis drugs in the initial treatment patients ranked the top three respectively as ethambutol,isoniazid and streptomycin in 2011,and the resistance rate of rifampin rose to the first place in 2019.The resistance rate of six kinds of anti-tuberculosis drugs in the retreatment patients ranked the top three respectively as isoniazid,ethambutol and rifampicin in 2011,and the resistance rate of rifampin rose to the first place from 2017 to 2019.5.The rifampicin resistant rate in positive bacteriological pulmonary tuberculosis patients ranged from 5.0%to 9.2%(P<0.001),which showed a decreasing trend(P=0.03).The rifampicin resistant rate among the initial treatment patients ranged from 3.2%to 5.8%(P<0.001),showed a decreasing trend(P=0.001).The rifampicin resistant rate among the retreatment patients was between 13.6%and 23.1%(P<0.001),showed a decreasing trend(P<0.001).6.There were a total of 2034 patients with rifampicin resistance,which of 1492 males(73.4%),The male-female ratio was 2.8:1.925(45.5%)cases were aged from 40 to 59 years.The Han nationality was dominant,with 1,214(59.7%)cases.There were 1708(84.0%)cases of farmers.A total of 1138 cases(55.9%)were retreatment patients.7.Isoniazid resistant rate in rifampicin resistant patients was between 25.2%?85.6%(P<0.001),which showed a decreasing trend(P<0.001).the initial treatment patients in rifampicin resistant patients,which isoniazid resistant rate was between 24.7%?80.4%(P<0.001),which showed a decreasing trend(P<0.001),the retreatment patients in rifampicin resistant patients,which isoniazid resistant rate was between 25.7%?96.0%<0.001),which showed a decreasing trend(P<0.001).8.Among rifampicin resistant patients,the resistance rate of ofloxacin ranged from 4.3%to 17.9%(P<0.001),showed a downward trend(P<0.001).the initial treatment patients in rifampicin resistant patients,which the resistance rate of ofloxacin was ranged from 4.6%to 16.7%(P=0.005),showed a downward trend(P=0.001).the retreatment patients in rifampicin resistant patients,which ofloxacin resistant rate was ranged from 0%to 21.1%(P<0.001),showed a downward trend(P<0.001).9.Treatment classification is highly correlated with the generation of drug resistance,and occupation has been shown to be an influential factor in the generation of rifampicin and ofloxacin resistance in partial years.Gender and age were the influencing factors of rifampicin resistance in partial years,while ethnic groups were the influencing factors of isoniazid and rifampicin resistance in partial years.10.95 patients was rifampicin resistance in Yunnan province center for disease control and prevention of tuberculosis treatment center in 2018 to 2019,According to the results of rapid diagnostic rifampicin drug-resistant mycobacterium tuberculosis mainly rpoB mutation in a gene loci,528-533 range was dominated,accounting for 57.9%(55/95).Secondly the gene mutation were in the range of rpoB 522-527,rpoB 507-511 and rpoB 511-517,which were 24.2%(23/95),10.5%(10/95)and 4.2%(4/95),respectively.Conclusions:1.The drug-resistant rate of tuberculosis has decreased significantly,and the drug-resistance epidemic of positive bacteriological tuberculosis patients has been effectively controlled in Yunnan province.2.The drug resistance rate of six kinds of anti-tuberculosis drugs in the patients with positive bacteriological tuberculosis decreased in different degrees.However,the rank of rifampicin resistance rate rose obviously,and the epidemic situation of rifampicin drug-resistant tuberculosis was not optimistic.3.The rifampicin resistant rate of tuberculosis has been decreasing,but the decreasing speed was slowly in Yunnan province.4.The rate of multidrug-resistant was downtrend in the positive bacteriological tuberculosis patients was mainly affected by the rate of isoniazid resistance to drop,In patients with rifampicin resistance,the drug resistance rate of isoniazid showed a downward trend.For patients with rifampicin resistance,isoniazid can be considered as a core drug to be added into the treatment plan when they switch to the second-line treatment regimen and the drug sensitivity results of the patients are clear.5.The drug resistance rate of quinolones was lower in patients with positive bacteriological tuberculosis,However,the drug resistance rate of quinolones was higher in patients with rifampicin resistance.6.The generation of drug resistance is influenced by gender,age,ethnicity,occupation,treatment classification and other factors.7.Rifampicin resistance of mycobacterium tuberculosis was dominated by rpoB 528-533 gene mutation,Secondly the gene mutation was rpoB 522-527,rpoB 507-511 and rpoB 511-517,respectively. |
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