摘要
目的对比分析全球与中国流感病毒对目前临床防治流感的主要抗病毒药物-神经氨酸酶抑制剂(Neuraminidase inhibitors, NAIs)的耐药性趋势及特征。方法收集WHO在2012年5月-2017年5月发布的全球流感病毒耐药性监测数据,以及我国CDC在2018年4月2日-2019年3月31日发布的《流感监测周报》数据,分别计算相关时期内流感病毒类别构成比、耐药发现率及耐药检出率等主要评估指标,并进行统计分析。结果全球五年内共收集63 342株流感病毒,其中甲型流感病毒株占66.73%(42 265/63 342),乙型占33.27%(21 077/63 342),未检测到丙型病毒;流感病毒对NAIs耐药检出率为0.76%(95%CI:0.69%~0.83%),五个年度间流感病毒株耐药检出率的比较差异有统计学意义(χ^2=254.23,P<0.001)。在中国2018-2019流感监测年度内,复核44 880株阳性流感病毒,其中甲型流感病毒阳性标本占比为88.29%(39 626/44 880),乙型占11.71%(5 254/44 880),未检测到丙型病毒;CNIC抽取了2 939株(1 974株甲型/H1N1、369株甲型/H3N2、596株乙型)阳性流感病毒进行耐药性监测,结果显示仅有12株甲型/H1N1毒株对NAIs的显示敏感性高度降低,甲型/H3N2和乙型流感毒株均对NAIs敏感;在冬春季流感流行期,耐药发现率(0.08‰)显著高于非流行期(0.01‰)(P=0.004)。结论目前中国NAIs耐药突变株较少,与全球发现流感病毒对NAIs呈低水平耐药趋势接近一致,表明NAIs仍适用于中国季节性流感病毒的预防和治疗;但是在冬春季流感流行期,流感病毒的耐药发现率显著高于非流行期,提示对于NAIs的耐药性监测和研究尤其值得进一步关注。
OBJECTIVE To investigate and compare the trend and characteristics of drug resistance of influenza viruses to neuraminidase inhibitors(NAIs), the major antiviral drug for clinical prevention and treatment of influenza, in China and around the globe. METHODS The surveillance data of drug resistance of influenza viruses around the globe that were issued by WHO from May 2012 to May 2017 were collected, and the data that were released in Influenza Weekly Report by Chinese CDC from Apr 2, 2018 to Mar 31, 2019 were also collected.The major evaluation indexes such as constituent ratios of influenza viruses, discovery rate of drug resistance and detection rate of drug resistance were respectively calculated and statistically analyzed. RESULTS A total of 63 342 strains of influenza viruses were collected around the globe within in the five years, 66.73%(42 265/63 342) of which were influenza A, 33.27%(21 077/63 342) were influenza B, and no influenza C strains were detected.The isolation rate of NAIs-resistant influenza viruses was 0.76%(95%CI:0.69%-0.83%), and there was significant difference in the isolation rate of drug-resistant influenza viruses strains among the five years(χ^2=254.23,P<0.001).Totally 44 880 strains of positive influenza viruses were reaffirmed in China during 2018-2019, 88.29%(39 626/44 880) of which were influenza A, 11.71%(5 254/44 880) were influenza B, and no influenza C strains were detected.Totally 2 939 strains of positive influenza viruses(1 974 strains of influenza A/H1 N1, 369 strains of influenza A/H3 N2, 596 strains of influenza B) were extracted for surveillance of drug resistance by CNIC, the result showed that there were only 12 strains of influenza A/H1 N1 virus that displayed highly declined susceptibility to NAIs and that the influenza A/H3 N2 and influenza B viruses were susceptible to NAIs;the discovery rate of drug resistance was 0.08‰ during the winter and spring influenza epidemic season, significantly higher than 0.01‰ during the non-epidemic season(P=0.004). CONCLUSION Few strains of NAIs-resistant mutant strains are isolated in China, which is closely consistent with the low level drug resistance of the influenza viruses isolated globally to NAIs, indicating that NAIs remains suitable for prevention and treatment of the seasonal influenza viruses in China;the discovery rate of drug resistance of influenza viruses is significantly higher during the winter and spring influenza epidemic period than during the non-epidemic period, suggesting that the surveillance and study of drug resistance to NAIs needs to be further strengthened.
作者
王莹丽
蒋艳
朱瑞芳
徐潜
曹彬
郭丽萍
WANG Ying-li;JIANG Yan;ZHU Rui-fang;XU Qian;CAO Bin;GUO Li-ping(China Japan Friendship Hospital,Beijing 100029;Beijing University of Chinese Medicine,Beijing 100029,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第2期272-277,共6页
Chinese Journal of Nosocomiology
基金
国家级重大科研基金资助项目(2017ZX10204401004)。
关键词
流感
流感病毒
神经氨酸酶抑制剂
耐药性
Influenza
Influenza virus
Neuraminidase inhibitor
Drug resistance
