嘉兴市全球基金耐多药肺结核防治策略分析

Analysis of prevention strategies of multidrug resistant tuberculosis of global fund in Jiaxing

目的分析嘉兴市全球基金耐多药肺结核防治策略实施效果,为今后耐多药肺结核发现、控制提供依据。方法对嘉兴市2013年1月1日～2015年6月30日可疑耐多药肺结核筛查、耐多药肺结核发现、治疗等监测数据进行回顾性分析。结果嘉兴市全球基金耐多药肺结核项目期内筛查可疑耐多药肺结核患者1636例,筛查率77.98%,培养阳性率71.03%,培养报告时间4～28 d,平均（16.00±4.52）d;筛查出耐多药肺结核患者45例,检出率2.75%;初始耐多药患者21例,初始耐多药率1.63%,复治耐多药患者25例,复治耐多药率6.96%,差异有统计学意义（χ^2=25.88,P〈0.05）;2013～2015年检出率呈逐渐下降趋势;其中28例患者（62.22%）进行了标准化方案治疗、患者6个月末痰菌转阴率为80.77%。结论嘉兴市全球基金耐多药肺结核防治模式取得阶段性成效,但复发患者纳入治疗率低,初始耐药与获得性耐药并存,规范复治管理、扩大初治筛查、改进诊断方法、阻断传播等问题需要今后解决。

Objective To analyze the implementation effect of multidrug resistant tuberculosis of global fund in Jiaxing and provide evidence for the further exploration and control of multidrug resistant tuberculosis. Methods The monitoring data of suspicious multidrug resistant tuberculosis screening, multidrug resistant tuberculosis exploration and treatment from January 1st, 2013 to June 30 th, 2015 was retrospectively analyzed. Results 1636 cases of suspicious multidrug resistant tuberculosis were screened during the Global Fund Multidrug Resistant Tuberculosis Project and the screening rate was 77.98%, cultivation positive rate was 71.03%, cultivation report time was 4 to 28 days with an average of 16.00±4.52 days; 45 cases of multidrug resistant tuberculosis were screened out with the detection rate of 2.75%; 21 cases of primary multidrug resistant tuberculosis with a primary multidrug resistant rate of 1.63%; 25 cases of retreat multidrug resistant tuberculosis with a retreat multidrug resistant rate of 6.96%. The differences had statistical significance（ χ^2=25.88,P〈0.05）; the detection rate presented a gradual decreasing trend from 2013 to 2015. 28 patients（62.22%） were given the standard treatment scheme and after six months, the sputum negative conversion rate was 80.77%. Conclusion The preventive mode of multidrug resistant tuberculosis of Global Fund in Jiaxing has gain periodical success, however there are also problems needing to be solved, for instance, low including treatment rate of relapse patients, co-existence of primary multidrug resistance and acquired multidrug resistance, retreatment administration, initial treatment screening, diagnostic method and spreading.