浙江省杭州市肺结核患者耐药监测结果分析

Surveillance for tuberculosis drug resistance in Hangzhou,Zhejiang

目的了解杭州市耐药结核病疫情现状及特点,为及时调整杭州市结核病控制策略提供依据。方法收集2011年杭州市登记所有涂阳患者痰标本,采用传统生化反应法进行菌型鉴定,采用世界卫生组织推荐的改良罗氏培养基比例法,进行异烟肼(Isoniazid,H)、利福平(Rifampicin,R)、乙胺丁醇(Ethambutol,E)、链霉素(Streptomycin,S)、氧氟沙星(Ofloxacin,O)和卡那霉素(Kanamycin,KM)的药物敏感性试验。利用结核病管理信息系统,收集患者人口学资料。结果全年共报告1845例涂阳患者,开展痰培养并培养阳性1394例,其中菌群鉴定为结核分枝杆菌并有药敏试验结果者1184例。1184例患者中对4种一线抗结核药物(H、E、R、S)的总耐药率为31.33%,总耐多药率为11.57%。广泛耐药率为0.90%,其中耐多药患者中,耐氧氟沙星者占29.93%,耐卡那霉素者占3.65%。一线药物耐药率由高到低依次为H(19.51%)、S(17.15%)、R(16.98%)和E(5.07%),复治患者耐药率明显高于初治患者。结论杭州市耐药结核病疫情相对较重,需进一步研究耐药病例合理的化疗方案,重点加强对初、复治患者的管理,从源头上减少耐多药甚至广泛耐药的发生。

Objective To investigate the prevalence of drug resistant tuberculosis （TB） in Hangzhou, Zhejiang provincec, and provide evidence for the revision of local TB control strategy. Methods Sputum samples were collected from all smear-positive TB patients registered in 2011 in Hangzhou and traditional biochemical reaction was done to identify the isolated strains. The strains＇ drug susceptibilities to Isoniazid, Rifampicin, Ethambutol, Streptomycin, Ofloxacin and Kanamycin were detected with modified Lowenstein-Jensen Culture Medium recommended by WHO. Results A total of 1845 smear-positive TB patients were registered in 2011, 1394 were culture positive, and 1184 were identified as Mycobacterium tuberculosis infections and had drug test results. Of the 1184 patients, 31.33% were resistant to at least one first-line drug, 11.57% were multi drug resistant （MDR）, 0.90% were extensively drug resistant （XDR）. Of the MDR patients, 29. 93 % were resistant to Ofloxacin, 3.65 % were resistant to Kanamycin. The drug resistant rates to Isoniazid, Streptomycin, Rifampicin and Ethambutol were 19.51%, 17. 15%, 16. 98%, and 5.07%, respectively. The drug resistant rate in re-treated cases was significantly higher than that in new cases. Conclusion The prevalence of drug resistant TB was high in Hangzhou, It is necessary to improve the chemotherapy for drug resistant cases and strengthen the management of new cases and re-treated cases to reduce the incidence of MDR- TB or XDR-TB.