医院和疾病预防控制机构合作防治耐多药结核病的研究

A study on the cooperation between centers for disease control and special tuberculosis hospitals for treatment and management of multi-drug resistant tuberculosis

目的 探索医院和疾病预防控制机构合作（简称医防合作）防治耐多药结核病的机制,提高耐多药结核病的发现率和治疗水平.方法 自2010年3月1日开始,在黑龙江省大庆市、浙江省衢州市、河南省濮阳市、天津市及重庆市万州区建立医防合作防治耐多药结核病机制,开展耐多药结核病的发现和治疗管理工作.收集干预前（2006年1月1日至2009年6月30日）和干预后（2010年3月1日至2012年2月29日）耐多药结核病的发现率、治疗效果及经济负担等方面的资料,并进行对比分析.结果 干预后研究地区68.4％（5 287/7 733）涂阳肺结核患者进行了结核病耐药检测,发现的耐多药肺结核病患者数是干预前的9.8倍;纳入耐多药结核病治疗的患者中,93.1％（108/116）使用了规范的初始化疗方案,是干预前的7倍.患者由医院转诊到疾病预防控制机构的到位率由干预前的0％（0/30）提高到干预后的92.8％ （90/97）;85.7％（83/97）的患者由疾病预防控制机构落实了治疗管理;6个月注射期结束时,干预后仍在治疗的患者为84.5％ （82/97）,痰培养阴转率为56.7％ （55/97）;干预后患者自付医疗费用比例、灾难性支出患者比例分别由干预前的75.4％（7 659/1 0158）和76.7％（23/30）下降到18.0％（1 678/9324）和44.7％（17/38）.结论 建立良好的医防合作机制,能够有效提高耐多药结核病患者的发现率和治疗效果.

Objective To improve the effectiveness of case detection and treatment of multi-drug resistant tuberculosis （MDR-TB） by implementing a mechanism of cooperation between hospitals and centers for disease control （CDC）.Methods Since 1 March 2010,a new mechanism of cooperation between hospitals and CDCs had been established in 5 cities including Daqing,Quzhou,Puyang,Tianjin and Wanzhou in China.Data of MDR-TB case-detection,treatment and economic burdens before the intervention （January 1,2006-June 30,2009） and after the intervention （March 1,2010-February 29,2012） were collected.Then all data were analyzed by statistical method.Results After the intervention,samples from 68.4％ （5 287/7 733） of smear-positive TB patients in the study regions underwent TB drug-resistant testing,and the number of the detected MDR-TB cases were 9.8 times that prior to the intervention.93.1％ （108/116） of the patients incorporated into the treatment of MDR-TB received the standardized initial chemotherapy program,and the number was 7 times that before the intervention.The referral rates after hospital discharge raised from 0％ before the intervention to 92.8％ after （90/97）the intervention; and 85.7％ （83/97） of the patients received treatment and management by CDC.When the 6-month injection ended,MDR-TB patients still under treatment after the intervention were 84.5％ （82/97）,and those whose sputum culture became negative were 56.7％ （55/97）.The proportion of patients with self-paid and with catastrophic expenditures after the intervention were reduced to 18.0％ （1 678/9 324） and 44.7％ （17/38） respectively,as compared to 75.4％ （7 659/10 158） and 76.7％ （23/30） respectively before the intervention.Conclusion To establish a well-performed Hospital-CDC cooperation mechanism could promote the performance of MDR-TB case detection and treatment.