云南省结核病耐药性调查

Drug Resistance Surveillance of Tuberculosis in Yunnan Province

目的通过对云南省结核病患者耐药情况进行调查,掌握全省耐药结核病的流行情况,为全省正在执行的结核病控制策略提供评价依据。方法按样本容量比例概率抽样方法,随机抽取30个县作为研究地点,收集2009-2011年登记的1 302例痰涂片抗酸杆菌阳性的初、复治肺结核病患者基本资料,并进行菌型鉴定和药敏试验。结果结核病总耐药率为37.91%（95%可信限,32.25%~40.57%）,耐多药率为7.46%（95%可信限,6.02%~8.90%）,广泛耐药率为0.39%（95%可信限,0.048%~0.73%）。其中,复治患者耐多药率为22.22%,初治患者为4.44%。二线抗结核药物中,氧氟沙星耐药率最低（2.59%）。结论耐药结核病已成为云南省结核病防治工作的重要挑战,在现有资源的情况下,应优先为复治结核病患者提供药敏检测,尽早发现耐药结核患者,有效控制耐药结核病传播。

Objective To acquire baseline data of tuberculosis（TB）drug resistance surveillance in Yunnan province,understand drug resistance epidemic status and to provide evaluation reference for the in-progress prevention and control strategies.Methods With proportion probability sampling method,30 counties were randomly selected as research sites.Basic data were collected from 1302 TB cases registered during 2009 to 2011,which were of acid-fast bacilli positive and received initial treatment and re-treatment.Identification of mycobacterium and drug sensitive test was conducted.Results The total resistance was 37.91%（95%CI∶32.25%-40.57%）;the multi-drug resistant（MDR）rate was 7.46%（95%CI∶6.02%-8.90%）;the extensive resistance was 0.39%（95%CI∶0.048%-0.73%）;the MDR rate of re-treated patients was 22.22% and that of initial treated patients were4.44%.Among the second-line anti-tuberculosis drugs,the resistance of Ofloxacin was only2.59%.Conclusion Drug-resistant TB has become a key problem to be solved in Yunnan province.To effectively control the spread of drug-resistant TB,drug susceptibility test should be provided to high-risk groups in time,particularly in re-treatment cases.