河南省结核菌耐药监测研究

Study on epidemic of drug-resistant tuberculosis in Henan Province,China

目的 :河南省作为世界卫生组织首轮全球结核菌耐药监测第一个中国成员 ,在全省 3 0个点进行了结核菌耐药监测 ,以评价现行结核病控制措施效果。方法 :按世界卫生组织 /IUATLD结核菌耐药监测指南实施。随机整群抽样 3 0个监测点。用抗结核药史小于 1月及 1月的涂阳肺结核顺序入选 ,对用药史进行了复核 ,痰标本抗酸染色 ,L J培养基培养 ,比例法作药敏 ,检查药物为链霉素 (S)、利福平 (R)、异烟肼 (H)、乙胺丁醇 (E) (SHRE) 4药。接受韩国跨国参比实验室 (SRL)质控并已达标 ,资料分析用世界卫生组织的SDRTB软件分析 ,χ2 检验等统计学处理。结果 :①入选 13 72例 ,无用药史 (含用药小于 1月 ) 916例 ,有用药史 (用药 1月 ) 45 6例 ;②始耐药率 43 0 % ,获得性耐药率68 2 % ,综合耐药率 5 1 4%。③各药初耐率S、H、R、E依次为 3 2 5 % ,3 1 0 % ,2 0 7% ,10 3 % ,获耐率相应为 5 2 2 % ,49 5 % ,48 3 % ,2 0 4%。④多耐药率 (至少H +R)初耐 16 5 % ,获耐 3 7 1%。结论 :河南省结核菌耐药形势严峻 ,相应的治疗成功率则明显较低 ,应引起卫生主管部门和社会各界高度重视。

Objective: To establish the surveillance system for drug resistance of tuberculosis according to WHO and IUATLD guidelines, and to evaluate the initial and acquired drug resistance in Henan Province. Methods: 30 of 157 counties/cities were randomly selected as surveillance points by cluster sampling from April to October 1996, in each of which 36 cases with smear positive pulmonary tuberculosis were continuously observed. Identification and susceptibility tests were done in all culture positive samples. Results: The total frequency of drug resistance was 51.4%, initial drug resistance 43.0%, initial multi drug resistance 16.5%,acquired drug resistance 68.2%, acquired multi drug resistance 37.1%. Conclusion: The results suggest that the initial drug resistance still ranks high in Henan Province,National TB Control Program should be further strengthened.