河南省2010年结核病流行病学抽样调查点细菌学检测结果分析

Analysis on bacteriology examination results of epidemiological sampling survey for tuberculosis sites of Henan province in 2010

目的了解河南省人群中结核分枝杆菌的流行特征。方法依据《全国第五次结核病流行病学抽样调查实施细则》的抽样规则,抽取河南省36个点代表,共涉及18个地市的36个县,实检49 091名,均进行X线摄片检查,共发现肺结核可疑症状者和(或)X线胸片异常者2877例,收集此部分人群的痰标本,对痰标本进行涂片镜检、分离培养、菌株鉴定,以及一、二线抗结核药物(异烟肼、利福平、乙胺丁醇、链霉素、对氨基水杨酸、卡那霉素、氧氟沙星、丁胺卡那霉素、卷曲霉素)的耐药试验。结果在2877例可疑肺结核患者中发现痰涂片阳性者35例,涂阳率1.22%;分离培养的2875例中获得45株结核分枝杆菌,结核分枝杆菌阳性率为1.57%,其中北京基因型菌株占91.11%(41/45),非北京基因型占8.89%(4/45)。肺结核患者任一耐药率和耐多药率分别为28.89%(13/45)、6.67%(3/45)。结论河南省结核分枝杆菌以北京基因型为主,仍为耐药结核病的高负担地区,需采取更加有效的防治策略和措施来控制结核病。

Objective To investigate the epidemiological characteristics of Mycobacterium tuberculosis in Henan province. Methods According to the inclusion criteria defined by the Guideline for the Fifth National Epidemiological Sampling Survey for Tuberculosis, 36 sites were selected in Henan to represent the tuberculosis prevalence in the province, which included 18 prefectures and 36 counties, 2877 cases with suspected pulmonary tuberculosis symptoms and/or abnormal chest were detectefl among 49 091 people by chest X-ray examination. Sputum specimens were collected from 2877 cases for smear, culture, strain identification and drug susceptibility test to first and second line anti-tuberculosis drugs, including INH, RFP, EMB, S, PAS, Km, Ofx, Am and CrrL Results 35 smear positive cases were detected among 2877 cases, and the smear-positive rate was 1. 22%. 45 isolated strains of smear positive cases were detected among 2877 cases, and the smear-positive rate was 1. 22%. 45 isolated strains of Mycobacterium tuberculosis from 2875 samples were acquired including 41 Beijing genotype strains （91.11%） and 4 non Beijing genotype strains, and the culture positive rate was 1.57 %（45/2875）. The rates of drug resistance and multidrug resistance among pulmonary tuberculosis cases were 28.89%（13/45） and 6.67%（3/45）. Conclusion The Mycobacterium tuberculosis Beijing genotype is dominant in Henan province. Henan province is still a high burden area of drug resistant tuberculosis and needs more effective strategy and measures for tuberculosis control.