摘要目的 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.

abstractsObjective 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.