背景:结核病(TB),全球最致命的传染病之一,在中国,耐药结核分枝杆菌(MTB)菌株的出现日益加剧。耐药结核病,包括单药耐药结核病,耐多药结核病(MDR-TB),和广泛耐药结核病(XDR-TB),带来了重大的公共卫生挑战。
方法:我们从2010年1月至2024年2月使用PubMed等数据库进行了系统的文献综述,Embase,WebofScience,谷歌学者。我们的重点是与新诊断的结核病例的耐药模式相关的经验数据。通过细致的过滤排除了非实证研究。对于荟萃分析,我们使用ReviewManager(RevMan)5.2,并使用纽卡斯尔-渥太华量表(NOS)评估证据质量.
结果:我们的搜索策略确定了40项符合纳入标准的研究,涵盖总样本量为87,667名参与者。在新的结核病病例中,中国MDR-TB的估计患病率为6.9%(95%CI:5.6-8.1%).一线抗结核药物的单药耐药率如下:异烟肼为18.2%(95%CI:16.4-20.6%),利福平为10.5%(95%CI:8.6-12.8%),和乙胺丁醇为5.7%(95%CI:4.1-7.3%)。链霉素耐药性的流行,以前的一线抗结核药物,17.1%(95%CI:14.6-19.1%)。其他类型的单药耐药患病率为15.2%(95%CI:13.9-17.3%),对于XDR-TB,为0.9%(95%CI:0.6-1.4%)。
结论:耐药结核病在中国的高流行带来了重大的公共卫生挑战。迫切需要有针对性的干预措施和持续监测,以打击耐药结核病的传播。
BACKGROUND: Tuberculosis (TB), one of the deadliest infectious diseases globally, is increasingly exacerbated in China by the emergence of resistant Mycobacterium tuberculosis (MTB) strains. Drug-resistant TB, including mono-drug resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB), presents significant public health challenges.
METHODS: We conducted a systematic literature
review from January 2010 to February 2024 using databases such as PubMed, Embase, Web of Science, and Google Scholar. Our focus was on empirical data related to drug resistance patterns in newly diagnosed TB cases. Non-empirical studies were excluded through meticulous filtering. For meta-analysis, we used
Review Manager (RevMan) 5.2 and assessed evidence quality using the Newcastle-Ottawa Scale (NOS).
RESULTS: Our search strategy identified 40 studies that met the inclusion criteria, encompassing a total sample size of 87,667 participants. Among new TB cases, the estimated prevalence of MDR-TB in China was 6.9% (95% CI: 5.6-8.1%). Prevalence rates for mono-drug resistance to first-line anti-TB medications were as follows: isoniazid at 18.2% (95% CI: 16.4-20.6%),
rifampicin at 10.5% (95% CI: 8.6-12.8%), and ethambutol at 5.7% (95% CI: 4.1-7.3%). The prevalence of streptomycin resistance, a former first-line anti-TB drug, was 17.1% (95% CI: 14.6-19.1%). The prevalence of other types of mono-drug resistance was 15.2% (95% CI: 13.9-17.3%), and for XDR-TB, it was 0.9% (95% CI: 0.6-1.4%).
CONCLUSIONS: The high prevalence of drug-resistant TB in China poses a significant public health challenge. There is an urgent need for targeted interventions and continued surveillance to combat the spread of drug-resistant TB.