陕西省肺结核耐药性监测分析

Analysis of drug resistance surveillance of tuberculosis in Shaanxi

目的为了获得陕西省肺结核耐药基线数据,为制定结核病控制对策提供依据。方法采用分层整群抽样,在全省108个县区中随机抽取30个县区做为监测点,采集调查期间新登记的痰涂片阳性肺结核患者痰标本进行分离培养和4种一线药物异烟肼(H)、链霉素(S)、利福平(R)、乙胺丁醇(E)及2种二线药物氧氟沙星(Ofx)、卡那霉素(Km)进行敏感性检测。结果有效病例数1 516例。其中初治1 086例,复治430例。总耐药率为30.34%,初治25.69%,复治42.09%,差异均有统计学意义(P<0.01);单耐药率为15.96%,初治14.36%,复治20.00%;多耐药率为6.07%,初治5.89%,复治6.51%;耐多药率为5.94%,初治3.50%,复治12.09%,差异均有统计学意义(P<0.01);广泛耐药率为0.40%,初治0.18%,复治0.93%;利福平耐药率为7.78%,初治4.79%,复治15.35%,差异均有统计学意义(P<0.01)。耐药谱有37种类型,其中单耐药5种,多耐药7种,耐多药11种(含广泛耐药2种),含二线药物的多耐药组合14种。结论陕西省耐药疫情严重,面临耐多药、利福平耐药挑战,耐药谱呈现多态性和复杂性,应采取强有力的干预措施,遏制耐药结核病的流行。

Objective To obtain the baseline data of drug resistant tuberculosis（TB） in Shaanxi Province,so as toprovide the evidence for formulating the strategy of TB control. Methods Thirty surveillance points（counties or districts）were randomly selected with the cluster sampling method among 108 counties（districts） of Shaanxi Province. According to thecase enroll criteria,all the smear positive TB patients during the survey period were involved and their sputum samples werecollected for the culture and drug resistant tests [isoniazid（H）,streptomycin（S）,rifampicin（R）,ethambutol（E）,ofloxacin（Ofx）,and kanamycin（Km）]. Results A total of 1 516 cases were selected in the surveillance. There were 1 086 new cases and 430 previously treated ones. The overall drug resistance rate was 30.34%（25.69% for the initial cases and 42.09% for theretreatment cases,and there was a significant difference between them,P〈0.01）. The mono-resistance rate was 15.96%（14.36% for the initial cases and 20.00% for the retreatment cases）. The poly-drug resistance rate was 6.07%（5.89% for theinitial case and 6.51% for the retreatment cases）. The multi-drug resistance rate was 5.94%（3.50% for the initial cases and12.09% for the retreatment cases,and there was a significant difference between them,P〈0.01）. The extensive drug resistancerate was 0.40%（0.18% for the initial cases and 0.93% for the retreatment cases）. The rifampicin resistance rate was 7.78%（4.79% for the initial cases and 15.35% for the retreatment cases,and there was a significant difference between them,P〈0.01）. There were 37 types of drug resistance spectrum,including 5 mono-resistance,7 poly-drug resistance,11 multi-drugresistance and 14 kinds of drug resistance of second-line drugs. Conclusions The prevalence of drug resistant TB is ratherhigh in Shaanxi Province. Facing the challenges of multi-drug resistance and rifampin resistance,and the resistant spectrumbeing polymorphism and complexity,we should take strong interventions to control the epidemic of drug resistant TB.