2012年青岛市结核病耐药性监测分析

Analysis of tuberculosis drug resistance in Qingdao

目的全面了解青岛市耐药结核病流行现状和特点，为制定和完善防控措施提供依据。方法2012年1月1日至2012年12月31日，依据wH0和国际防痨和肺部疾病联合会（IUATLD）结核病耐药监测指南，收集青岛市2012年连续新发涂阳肺结核患者938例和同期新登记的复治涂阳肺结核患者42例，对成功分离的980例结核分枝杆菌菌株，采用比例法对利福平（R）、异烟肼（H）、链霉素（S）、乙胺丁醇（E）等4种药物进行药物敏感性试验。采用SPSS18．0进行统计学分析，率的比较采用卡方检验，以P〈0．05为差异有统计学意义。结果2012年青岛市新发涂阳肺结核患者与复治涂阳肺结核患者的总耐药率为22．45％（220／980），初治患者耐药率为21．75％（204／938），复治患者耐药率为38．10％（16／42）；总耐多药率为4．69％（46／980），初治患者耐多药率为4．05％（38／938），复治患者耐多药率为19．05％（8／42），复治患者耐多药率明显高于初治患者耐多药率（X2=20．21，P〈0．01）。结论青岛市耐药疫情仍然较重，面临耐多药结核病的挑战，结核病耐药谱呈多态性和复杂性，需采取更全面、更积极的干预措施遏制耐药结核病疫情。

Objective To understand the epidemic situation and characteristic of drug resistant tuberculosis （DR-TB） in Qingdao and to provide scientific evidence for the development and improvement of TB control strategies. Methods According to the anti-TB drug resistance guidelines issued by WHO/IUALD, 938 new smear positive cases and 42 new registered retreatment smear positive cases in 2012 were included in the surveillance. A total of 980 strains of Mycobacterium tuberculosis were isolated and proportion method were applied in drug susceptibility test （DST） for rifampicin （R）, isoniazid （H）, streptomycin （S） and ethambutol （E）. , chi-square was used for fre- quencies comparison. Statistical analyses were performed using SPSS （Statistical Package for Social Sciences, USA）, version 18. 0. P^0.05 was considered statistically significant. Results The overall drug resistance rate was 22.45% （220/980）, 21. 75% （204/938） and 38.10M （16/42）for initial and acquired drug resistance respectively. The total multidrug resistance （MDR） rate was 4.69% （46/980）, 4.05% （38/938） and 19. 05% （8/42） respectively for initial and acquired multidrug resistance. The rate of acquired multidrug resistance was significantly higher than initial multidrug resistance （X2 =20.21, P〈0.01）. Conclusion The TB burden especially MDR-TB is still very serious in Qingdao. TB drug resistance spectrum is diversity and complexity, we need to adopt more com- prehensive, more active intervention measures to curb the epidemic of drug-resistant tuberculosis.