浙江省耐药结核病现状及趋势研究

Developing status and tendency of drug resistant tuberculosis in Zhejiang

目的了解浙江省耐药结核病疫情现状和变化趋势,评价DOTS策略执行的效果。方法按WHO/IUATLD《结核病耐药监测指南》的要求对新登记涂阳肺结核病人进行耐药结核病监测,并与浙江省1998/1999年第一次耐药监测结果进行比较。结果30个监测点共入选病人1 127例,对988株结核分枝杆菌进行4种抗结核药物(H、S、R、E)的耐药性测定,总耐药率30.6%,其中初始耐药率为26.6%,初始耐多药率为3.7%,获得性耐药率为51.9%,获得性耐多药率为29.2%。初始耐药病例中,65.8%仅对1种药物耐药,4种药物的耐药率顺位由高到低依次为:S(19.2%)、H(12.4%)、R(5.0%)、E(4.0%),对1种和2种及以上药物的初始耐药率分别为17.5%和9.0%。与1998/1999年相比,全省初始耐药率上升显著(χ2=34.606,P=0.000),耐多药率水平则呈现下降趋势,结核分枝杆菌耐药性发生更趋向于耐单一药。结论浙江省耐多药结核病情况虽有所改善,但耐药结核病疫情依然十分严峻,进一步提高DOTS质量是当务之急。

Objective To understand the developing status and tendency of drug resistant tuberculosis in Zhejiang, and to evaluate the effect of ongoing DOTS strategy. Methods The Guidelines for Surveillance ofDrug Resistance in Tuberculosis of WHO/IUATLD were followed in registration smear positive TB and comparing the result of surveillance for tuberculosis bacteria drug resistance with the results of the first drug resistance surveillance in 1998/1999. Results 1 127 TB patients were enrolled in 30 counties. Drug susceptibility testing against streptomycin （S）, isoniazid （H）, rifampiein （R） and ethambutol （E） were performed in 988 cases. The total drug resistance rate was 30.6 %, the initial drug resistant rate was 26.6 %, the initial multi-drug resistance was 3.7 %, the acquired drug and multi-drug resistant rates were 51.9 % and 29.2 %, respectively. Among the new cases with drug resistant tuberculosis, 65.8 % of the cases showed resistance to single drug. The order of initial drug resistance rate from high level to low level was S （19.2%）, H （12.4%）, R （5.0%）, E（4.0% ）. The initial drug resistant rates of single drug and at least 2 drugs were 17.5% % and 9.0% respectively. The initial drug resistant rates was increasing（ X2 = 34. 606, P = 0. 000）while the initial multi-drug resistance showed a decreasing trend in comparison with 1998/1999, which will produce more Mycobacterium tuberculosis strains of single drug resistance in a specific number of strains in Zhejiang. Conclusion The MDR- TB epidemic was improved, but drug resistant TB was still quite serious in Zhejiang. It is the top priority to further improve DOTS quality.