湖北省结核分支杆菌耐药性监测研究

Surveillance of drug resistant tuberculosis in Hubei, China

目的 建立以世界卫生组织 (WHO)和国际防痨和肺病联合会 (IUATLD)指南为基础的结核病耐药监测系统 ,掌握湖北省初始和获得性耐药水平 ,评价现行结核病控制策略效果。方法 采用整群抽样方法 ,在全省随机抽取 3 0个县 (市、区 )为监测点 ;各监测点连续选 3 0个新发涂阳肺结核病例 ,期间的其他涂阳病例同时纳入 ,并对全部培养阳性菌株进行菌型鉴定及SM、INH、RFP、EMB 4种抗结核药物的药敏试验 (比例法 )。结果 共入选 113 6例 ,其中培养阳性 10 97例 ,培养阳性率为96 6% ,污染率为 0 4%。总耐药率为 2 3 3 % ,其中初始耐药率为 17 5 % ,获得性耐药率为 44 5 %。初始耐多药率 (含H +R)为 2 1%。获得性耐多药率为 2 1 8%。结论 初步建立了抗结核药物耐药性监测实验室方法和质量控制机制 ,首次获得可信的全省耐药水平资料。

Objectives To establish a surveillance system for antituberculous drug resistance according to WHO and IUATLD guidelines, to collect the data of initial and acquired drug resistance, and to evaluate the efficacy of ongoing tuberculosis control strategies Methods Thirty counties (or cities or districts) were randomly selected as surveillance points by cluster sampling Thirty new cases of smear positive pulmonary tuberculosis in each cluster were enrolled consecutively Bacterial typing and susceptibility tests (proportion method for SM,INH,RFP and EMB) were done in all culture positive samples Laboratory quality control was implemented by Korean Super country Reference Laboratory Data were analyzed by WHO SDRTB2 software Results 1 136 patients with pulmonary tuberculosis were enrolled in 30 clusters, among them 1 097 were culture positive Smear positive culture positive rate was 96 6% and the contamination rate was 0 4% The total drug resistance rate was 23 3%, the initial drug resistance being 17 5% and the acquired drug resistance being 44 5% The initial multi drug resistance rate (H+R) was 2 1% and the acquired multi drug resistance rate (H+R) was 21 8% Conclusions Laboratory methods for surveillance of drug resistant tuberculosis and quality control were established, and reliable data on the status of antituberculous drug resistance in Hubei province were collected The results showed that implementation of DOTS and regular surveillance were very important