第四次全国结核病流行病学抽样调查——结核分支杆菌耐药性分析与评价

Drug resistance of Mycobacterium tuberculosis in a nationwide epidemiological survey in China in the year of 2000

目的 分析我国结核分支杆菌耐药现状 ,为评价和指导国家结核病控制规划 (NTP)提供基本数据。方法 对第四次全国流调的分离菌株进行 6种抗结核药物 (INH、SM、RFP、EMB、PAS Na和TB1)的耐药性测定。结果 392株结核分支杆菌的总耐药率为 2 7 8% ,初始耐药率和获得性耐药率分别为 18 6 %和 46 5 % ;耐多药率为 10 7% ,其中初始和获得性耐多药率分别为 7 6 %和 17 1% ;6种抗结核药物的耐药率由高到低分别为INH(17 6 % )、SM (17 3% )、RFP(16 6 % )、PAS Na(2 8% )、EMB(1 5 % )和TB1(1 3% ) ;耐 1种、2种、3种和 4种以上药物的初始耐药率和获得性耐药率分别为7 6 %、4 6 %、4 6 %、1 9%和 14 7%、19 4%、10 1%和 2 3% ;不同性别、年龄组初始耐药差异无显著性。结论 本次流调的总耐药率、初始耐药率与第二次和第三次流调资料比较有显著性降低 (P <0 0 1) ,但仍处于较高水平 ,且耐药性的发生更趋向于对主要一线药物耐药和对多种药物耐药 ,尤其是MDR TB发生率高 ,应引起重视。

Objective To determine the state of anti-tuberculosis drug resistance, and to analyze the trend of drug resistance rate and assess its impact on National TB Programme (NTP). Methods 392 Mycobacterium tuberculosis (MTB)isolates from a nationwide epidemiological survey were subjected to susceptibility testing against 6 anti-tuberculosis drugs using the absolute concentration method. Results The resistant rate to any drug was 27.8% in all MTB isolates, 18.6% in 263 new cases and 46.5% in 129 previously treated cases. Multi-drug resistant rate (MDR) was 10.7%. Initial and acquired MDR was 7.6% and 17.1%. Any resistance to INH, SM,RFP, PAS-Na, EMB and TB_1 was 17.6%, 17.3%, 16.6%, 2.8%, 1.5% and 1.3% , respectively. The resistant rates to 1, 2, 3 and 4 or more drugs were 7.6%, 4.6%, 4.6% and 1.9% in new cases and 14.7%, 19.4%, 10.1% and 2.3% in previously treated cases. The initial drug resistant rate did not show significant difference ( P >0.05) among different sex and age groups.Conclusions Compared to the previous data, the total drug resistance and initial drug resistance decreased significantly, but were still high. More attention should be paid to the trend of resistance of MTB to first-line drugs and especially the high incidence of MDR-TB.