重庆市六区(县)耐多药肺结核患者发现治疗现状分析

The analysis of current situation on the detection and treatment of MDR-TB patients in six districts and counties of Chongqing city

目的通过分析重庆市6个区（县）的耐多药肺结核患者发现和治疗情况，为探索重庆市的耐药结核病防治模式提供科学依据。方法对三峡库区6个区（县）收集的1189例涂阳肺结核患者进行传统药敏试验，其中1015例新涂阳肺结核患者，174例耐多药肺结核高危人群；根据耐多药肺结核患者发现和治疗数据，分析不同类型肺结核患者中的耐多药肺结核检出率、菌株运输情况及确诊耐多药肺结核患者未纳入治疗的原因。结果1189例涂阳肺结核患者中，84例（7．1％）确诊为耐多药肺结核。不同性别耐多药检出率比较，男性为6．9％（61／883）、女性为7．5％（23／306），不同性别间差异无统计学意义（χ2=0．07，P〉O．05）；不同年龄组间耐多药检出率比较，≤20岁、〉20～岁、41～岁、61～80岁分别为6．9％（7／102）、8．7％（25／286）、7．8％（39／499）、4．3％（13／302），不同年龄组问差异无统计学意义（χ2=2．15，P〉0．05）；从患者分类来看，新涂阳肺结核患者的耐多药检出率为3．6％（37／1015），高危人群检出率为27．0％（47／174），差异有统计学意义（χ2=123．5，P〈0．01）。耐多药可疑患者留痰至开展药敏试验的总体时间间隔平均为90．9d（66．0-118．9d）。84例确诊耐多药肺结核患者中，22例纳入治疗，纳入治疗率为26．2％（22／84）；62例未纳入治疗，经济困难为未纳入治疗的第一位原因，其患者占41．9％（26／62）。结论重庆市耐多药肺结核发现的筛查对象应为高危人群，应就近设立定点医院耐多药肺结核规范化诊疗管理点，并落实医保政策，解决患者的诊疗费用，以保障患者进行规范化治疗。

Objective For the purpose of providing scientific evidence for the prevention and treatment model of drug-resistant TB, we analyzed the current situation on the detection and treatment of MDR-TB patients of 6 dis- tricts and counties in Chongqing. Methods All 1189 smear-positive patients were collected from the 6 districts and counties of the 3 Gorges reservoir region.1015 cases were new smear-positive TB patients and 174 cases were from high risk patients of MDR-TB. The drug-susceptibility test results, transporting situation and the causes who were not included in the treatment were analyzed. Results Among 1189 smear-positive patients,84 cases（7, 1%）were diagnosed as MDR-TB. Comparing multidrug-resistant detection rate in different gender, the male was 6.9% （61/883）, the female was 7.5% （23/306）; there was no statistical differences between genders with the detection rate of multidrug-resistant（χ2=0.07, P〉0.05）. Comparing different age groups,≤20 years,〉20 years- ,41 years- and 61-80 years old were 6.9% （7/102）, 8. 7% （25/286）, 7.8% （39/499）, 4. 3% （13/302） respectively; there was no statistical differences between different age groups with the detection rate of multidrug-resistant（χ2 =2.15, P〈0. 05）. From the point of patient classification, new smear-positive pulmonary tuberculosis patients with multi- drug-resistant detection rate was 3.6% （37/1015）, the detection rate from high risk population was 27.0% （47/174）, the difference was statistically significant （χ2= 123.5,P〈0.01）. The overall time interval （d） for sus- pected multi-drug resistant patients between leave phlegm to carry out drug sensitive test was an average of 90. 9 d （66.0-118.9 d）. In 84 cases of multi-drug resistant TB diagnosis, 22 cases received treatment, the treatment rate was 26.2% （22/84） ; and 62 cases were out of treatment and economic difficulties was the priority reason accounting for 41.9 %（26/62）. Conclusion The screening for MDR-TB should target at the high risk population in Chongqing city, we should set up standardized diagnosis and treatment management points of MDR-TB nearby designated TB hospitals, and carry out medical insurance policy, addressing patient clinic costs, in order to ensure patients＇ s standardized treatment.