海南省结核病耐药状况调查研究

Epidemic characteristics of tuberculosis drug-resistant in Hainan Province

目的了解海南省耐药结核病流行现状和特点,为下一步制定和完善防控措施提供科学依据。方法将全省18个市县均纳入调查点,通过调查问卷获取患者临床信息,采用比例法对异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)、氧氟沙星(Ofx)和卡那霉素(Km)等6种药物进行敏感性检测。结果本次调查共发现非结核分枝杆菌感染81例,占全部培阳病例的6.3%,其中初治53例,复治28例。全省总耐药率为20.9%,获得性耐药率(28.7%)高于初始耐药率(18.4%)(P<0.05);耐多药率达到7.5%,获得性耐多药率(17.1%)高于初始耐多药率(4.5%)(P<0.05);12.6%的耐多药为广泛耐药,广泛耐药率达1.0%。通过6种药物的药敏检测,共计发现结核病耐药谱型29种,包括单耐药5种、多耐药13种、耐多药11种(含广泛耐药3种)。结论海南省结核病耐药水平相对较低,但仍面临着耐多药、广泛耐药结核病的威胁,需要采取全面、积极的干预措施遏制耐药结核病的流行。

Objective To understand the prevalence and characteristic of drug- resistant tuberculosis（DR- TB） in Hainan Province, we provide evidence base for strategy development. Methods Eighteen counties in Hainan Province were selected as sample. The clinical information of patients were collected through questionnaires and proportion methods were employed in drug susceptibility test（DST） for rifampicin, isoniazid, streptomycin, ethambutol, ofloxacin and kanamycin.Results This study found a total of 81 cases of non-tuberculous mycobacteria infection, accounting for 6.3% of all culture positive cases, among which 53 were new smear positive cases and 28 were retreatment cases. The total drug-resistant rate（DRR） were 20.9%, acquired DRR（28.7%） were higher than primary DRR（18.4%）（P〈0.05）. Multidrug-resistant rate（MDRR）were 7.5%, with higher acquired MDRR（17.1%） than primary MDRR（4.5%）（P〈0.05）. 12.6% of MDR-TB cases were proved to be extensively drug-resistant tuberculosis（XDR-TB） which were 1.0% of total. Through the DST of six drugs, 29 types of drug-resistant spectrum were found including 5 types of single DR, 13 types of poly-resistant and 11 types of MDR（including3 types of XDR-TB）. Conclusions Although the DR-TB ranks was low, Hainan Province still face the threat of MDR-TB and XDR-TB. We should take comprehensive measures to curb the prevalence of DR-TB.