山东省耐多药肺结核可疑者筛查情况分析

Respective study on situation of suspects screening of multidrug resistant tuberculosis in Shandong province

目的回顾性分析山东省全球基金耐多药肺结核防治项目中可疑者筛查情况,探索并完善耐多药肺结核患者的发现策略。方法在项目地区以耐多药肺结核患者的密切接触者、涂片阳性的慢性和复治失败、初治失败、复发、返回及治疗3个月末痰涂片仍阳性的初治涂阳患者等重点人群为主要筛查对象,进行结核菌培养和药敏试验,分析不同人群中耐多药及广泛耐药肺结核的筛出情况。结果开展培养的4318例涂片阳性的耐多药肺结核可疑者中,培养阳性3315例(82.5%);开展药敏试验的3296例可疑者中,422例(14.3%)被诊断为耐多药肺结核,16例(0.5%)被诊断为广泛耐药肺结核,其中复治失败患者中耐多药及广泛耐药肺结核检出率最高,为64.5%,初治失败患者中耐多药及广泛耐药肺结核检出率较高,为41.2%,新患者中耐多药及广泛耐药肺结核检出率较低,仅为6.6%。结论重点人群筛查是一种高效的耐多药肺结核患者的筛查策略,值得在山东省其他地市推广应用。

Objective The paper conducted an analysis on results of suspects screening in areas implementing Shandong Global Fund muhidrug resistant tuberculosis project was to provide reference data for government to control prevalence of multidrug resistant tuberculosis. Methods Chronic and retreatment failure smear positive cases,close contracts of MDR- TB,treatment failure cases,relapse cases,return cases and initial cases that smear positive at the end of three months using drug susceptible test were screened by TB dispensaries,and indexes of confirmed MDR-TB and XDR-TB were calculated and compared between different groups. Results Among of the 4 318 suspects observed,culture positive 3 315 （82.5%）;among of 3 296 suspects had done DST,422（14.3%）were confirmed as MDR-TB,16（0.5%）were confirmed as XDR-TB,among of which,MDR-TB or XDR-TB in retreatment failure was highest,that was 64.5%,the rate of MDR-TB or XDR-TB in treatment failure was relatively higher,which was 41.2%. In contrast,the screening rate among new cases was relatively lower,which was 6.6%. Conclusion The screening of high risk populations said above is effective and should be promoted and popularized in Shandong.