普陀区外来人口与户籍人口肺结核患者耐药性分析

Drug resistance in tuberculosis compared between resident and migrant patients

[目的]分析普陀区外来人口与户籍人口肺结核患者耐药性的异同。[方法]收集普陀区肺结核门诊痰涂片及结核分枝杆菌培养均阳性的病例资料,采取随即抽样的方法将其分为两组,外来人口组598例,户籍人口组600例。痰涂片阳性患者采用绝对浓度法进行结核分枝杆菌培养,并对分离菌株进行4种抗结核药耐药性测定。[结果]598例外来人口肺结核病例中痰培养阳性患者耐药率为28.3%,其中初治患者耐药率为19.6%,复治患者耐药率为48.5%,治愈率为84.6%。600例户籍人口肺结核病例中痰培养阳性患者的耐药率为23.2%,其中初治患者耐药率为15%,复治患者耐药率为41.3%,治愈率为87.0%,两组间总耐药率差异无统计学意义。外来人口男、女复治肺结核患者耐药率都比户籍人口高,且以青壮年为主,户籍人口耐药病例主要发生在中老年。外来及户籍人口初治耐药病例都以耐单药为主,复治病例则以耐多药为主。[结论]外来人口和户籍人口肺结核均处于高耐药状态,应引起足够重视。继续贯彻现代结核病控制策略,进行全程规则化疗及耐药性监测,以减少耐药结核病例的发生。

[Objective] To determine the difference in drug resistance of M.tuberculosis（TB） between resident TB cases and migrant TB cases on data from Putuo Central Hospital. [Methods] There were 598 migrants and 600 residents included and the latter were as control group.Proportional method with Lwenstein-Jensen culture medium was used for susceptibility test on 4 antituberculosis drugs. [Results] Total drug resistance rate in 598 smear-positive migrant TB cases was 28.3%,of which the rates of first treated and re-treated patients were 19.6% and 48.5% respectively,and the total cure rate was 84.6%.Total drug resistance rate in 600 smear-positive resident TB cases was 23.2%,of which the rates of first treated and re-treated patients were 15% and 41.3% respectively,and the total cure rate was 87.0%.There was no significant difference in total drug resistance rates between the two groups.The drug resistance in migrant TB cases,both male or female,was higher than that in resident TB cases.The drug-fast cases in initial treatment among residents and migrants were both mainly single drug fast cases,while most of those in re-treatment were nearly multitude drug fast cases.Most of the drug fast cases in migrants were youths,while most of those in residents were old men. [Conclusion] The rates of drug resistance were found to be high in both migrant and resident TB cases.So up-to-date TB control program must be implemented continuously to decrease the occurrence of drug resistance in tuberculosis.