2006～2008年北京市怀柔区结核病药物耐药性监测

Surveillance of drug resistance in patients with pulmonary tuberculosis in Huairou District,Beijing during 2006～2008

目的了解北京市怀柔区结核病药物耐药情况,评估怀柔区结核病防治效果,为制定新的怀柔区结核病防治规划(2010～2015)提供依据。方法对怀柔区结核病防治所2006年1月1日～2008年12年31日登记的该辖区初治菌阳肺结核患者结核分枝杆菌复合群进行分离培养,培养出的菌株全部送北京市结核病控制研究所实验室进行异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)耐药性检测。结果该辖区129例初治菌阳病例为此次入选病例,初始敏感菌株113例,初始敏感菌株率为87.6%,耐药菌株22例,初始耐药率12.4%,耐多药(MDR)7例,初始耐多药率为5.4%,以上两种耐药率均低于北京市及全国平均水平[1-2]。结论由于怀柔区30年来采取的现代结核病控制策略(DOTS),使肺结核病人得到有效的规律治疗,避免乱用药现象,减少了初始耐药病例的产生,为今后更有效地控制结核病流行打下了良好的基础,并为制定新的怀柔区结核病规划提供了科学的依据。

Objective To understand drug resistance in patients with pulmonary tuberculosis （TB） in Huairou district, Beijing and evaluate effectiveness of TB control there to provide scientific basis for formulating plans of TB control in Huairou district in 2010 - 2015. Methods Myeobacterium tuberculosis （ M tuberculosis） complex were isolated from patients of pulmonary TB with sputum smear positive for acid-fast bacteria registered and primarily treated at TB dispensary of Huairou district during January 1, 2006 to January 31, 2008. Cultured bacteria strains were tested for sensitivity to isoniazid （ H）, rifampicin （ R）, streptomycin （S） and ethambutol （E） at Beijing Institute for TB Control in Tongzhou, Beijing. Results In total, 129 patients with pulmonary TB primarily treated at Huairou district were recruited in the study, including 113 cases （87.6%） with primarily drug-sensitive strains, 22 （ 12.4% ） drug-resistant ones, and seven （5.4%） with multi-drug-resistant ones, lower of the latter two than those as average level in Beijing and at national level. Conclusion With implementation of modern tuberculosis control strategy （directly observed therapy short term, DOTS） for 30 years at Huairou district, patients with pulmonary TB have received standard and effective treatment avoiding phenomena of irregular drug use and reducing cases of primary resistance to anti-TB drugs, thus lay a better foundation for more effective control of TB epidemic and provide scientific evidence for development of new TB control plans in the future at Huairou district.