我国肺结核病耐药状况的综合分析

Meta-analysis of the Status of Drug Resistance of Tuberculosis in China

目的分析近20年来肺结核病耐药情况,为临床治疗提供参考,为改进肺结核病防治措施提供科学依据。方法采取综合分析的方法对1990～2009年肺结核病耐药监测结果进行综合分析。结果 20年来的文献系统分析表明初始耐药率为30.1%,获得性耐药率为65.6%,总耐药率为43.8%;初始耐多药率为8.5%,获得性耐多药率为31.7%,总耐多药率为19.3%。2000-2009年间的初始耐药率、获得性耐药率和总耐药率以及初始耐多药率相对于1990至1999年间均有所下降,差异均有统计学意义。初始耐药以耐SM和INH最多,耐药率为40.9%和40.8%;获得性耐药和总耐药均以耐INH最多,耐药率分别为47.0%和30.4%。在初始耐药中,耐一药和耐多药的比例分别为47.7%和26.6%,差异有显著性。在获得性耐药中,耐一药和耐多药的比例分别为26.3%和49.3%,差异有显著性。结论我国初始耐药率、获得性耐药率以及总耐药率均处于较高水平,获得性耐药以耐多药为主,耐药形势十分严峻。

Objective To analyze the status of drug resistance of pulmonary tuberculosis（TB）,and provide scientific evidence for further improvement of TB control strategies.Methods？Meta-analysis was applied to comprehensively analyze the status of drug resistance of pulmonary tuberculosis from 1990 to 2009.Results？According to the systematic analysis of the literature in the past 18 years,the primary drug resistance rate was 30.1%,the acquired drug resistance rate was 65.6%,total drug resistance rate was 43.8%;the primary multi-drug resistance rate was 8.5%,the acquired multi-drug resistance rate was 31.7%,total multi-drug resistance rate was 19.3%.The rates of the primary drug resistance,the acquired drug resistance and the total drug resistance rate and the primary multi-drug resistance in 2000～2009 years were lower than that in 1990-1999 years respectively,there were significant differences among them.The primary drug resistance to SM and INH were most important,the rates were 40.9% and 40.8% respectively;the acquired drug resistance and total drug resistance to INH were most important,the rates were 47.0 and 30.4% respectively.The ratios of the drug resistance to one drug,and multi-drug were 47.7% and 26.6% in the primary drug resistance,there were significant differences among them.The ratios of the drug resistance to one drug and multi-drug were 26.3% and 49.3% in the acquired drug resistance,there were significant differences among them.Conclusion？The rates of the primary drug resistance,the acquired drug resistance and multi-drug resistance are high,the multi-drug resistance are important in acquired drug resistance,and the situation of drug resistance is still quite serious.