惠州市耐药结核病筛查结果分析

Analysis on the screening results of drug- resistant tuberculosis in Huizhou City

目的了解惠州市肺结核患者的耐药筛查情况。方法对2009-2014年全球基金结核病防治项目实施期间全市涂阳肺结核患者的耐药检测结果进行分析。结果 (1)全市登记涂阳患者耐药筛查率21.66%。其中初治涂阳患者筛查率18.80%;复治涂阳患者筛查率41.56%。(2)涂阳患者耐药率46.63%、耐多药率16.34%。初、复治涂阳患者耐药率38.37%、71.30%和耐多药率7.96%、41.36%。初、复治涂阳患者耐药率、耐多药差异有统计学意义(χ2=105.75、197.95,P<0.01)。(3)对4种一线抗结核药物的耐药顺位(耐药率)由高至低是链霉素(S,32.0%)、异烟肼(H,25.49%)、利福平(R,21.02%)和乙胺丁醇(E,15.29%),耐多药以耐4种药物的最多(8.39%),其次是耐HR(3.14%)、耐HRE(2.35%)以及耐HRS(2.27%)。结论惠州市结核病患者耐药筛查率较低,对1 291例菌株的耐药分析显示耐药率、耐多药率偏高。今后应继续加大耐药结核病筛查力度、加强结核病实验质量控制,提高全市耐药结核病防治效果。

Objective To explore the screening results of drug- resistant pulmonary tuberculosis in Huizhou City. Methods The drug- resistant data of pulmonary tuberculosis cases enrolled in the Global Fund Project from 2009 to 2014 in Huizhou City were analyzed. Results The overall drug resistance screening rate of the smear- positive pulmonary tuberculosis patients in Huizhou City was 21. 66%,with 18. 80% for new patients and 41. 56% for retreatment patients. The overall drug- resistant rates and the multidrug- resistant rates of the smear- positive pulmonary tuberculosis patients were 46. 63% and 16. 34% respectively.Statistical difference could be found between new patients and retreatment patients not only in drug resistant rate（ 38. 37% vs. 71.30%,χ2= 105. 75,P 〈0. 01）,but also in multidrug resistant rate（ 7. 96% vs. 41. 36%,χ2= 197. 95,P〈 0. 01）. The drug- resistant spectrum in descending sequence was streptomycin（ S,32. 0%）,isoniazide（ H,25. 49%）,rifampicin（ R,21. 02%） and ethambutol（ E,15. 29%）. The multidrug- resistant spectrum in descending sequence was HRES（ 8. 39%）,HR（ 3. 14%）,HRE（ 2. 35%） and HRS（ 2. 27%）. Conclusions The resistance screening rate of the smear- positive pulmonary tuberculosis patients in Huizhou City is low. The overall drug- resistant rate and multidrug- resistant rate are relatively high in the 1,291 cases.Improving the drug resistant screening and intensifying the quality control of tuberculosis laboratory are strongly recommended to facilitate tuberculosis control in Huizhou City.