全国结核病流行病学抽样调查及各省耐药监测中耐药结核病疫情资料分析  

Drug resistant tuberculosis in China—a analysis on results of national tuberculosis epidemiological sampling surveys and drug resistance surveillance

作　　者：陈诚[1,2] 李仁忠[1] 陈明亭[1] 赵雁林[1] 王黎霞[1] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心耐药防治部,北京102206 [2]北京师范大学社会发展与公共政策学院,北京100875

出　　处：《疾病监测》2013年第4期265-268,共4页Disease Surveillance

摘　　要：目的对我国耐药肺结核的流行现状展开分析,为制定相关政策提供科学依据。方法分析1990、2000和2010年三次全国结核病流行病学抽样调查资料(未包括香港、澳门和台湾地区,以下同)中不同药物的初始耐药率以及获得性耐药率的变化趋势,比较全国12个省耐药率及耐多药率的差异。结果根据目前我国1990、2000、2010年三次结核病流行病学抽样调查结果显示,异烟肼和链霉素的初始耐药率呈现上升趋势(P<0.01),乙胺丁醇和对氨水杨酸钠的初始耐药率呈现1990年和2010年高,而2000年低,差异有统计学意义(P<0.01),利福平的初始耐药率和获得性耐药率呈现1990年和2010年低,而2000年高(P<0.01),丙硫异烟胺的初始耐药率和获得性耐药率在2000年比1990年呈现显著下降趋势(P<0.01)。在12个省的耐药监测资料中,初始耐药率最高的是辽宁省(42.1%),最低的是上海市(14.5%),获得性耐药率最高的是黑龙江省(67.7%),最低的是上海市(27.5%),总耐药率最高的是内蒙古自治区(44.8%),最低的是上海市(18.0%)。初始耐多药率最高的是辽宁省(10.4%),最低的是湖北省(2.1%),获得性耐多药率最高的是内蒙古自治区(36.8%),最低的是新疆维吾尔自治区(7.9%),总耐多药率最高的是内蒙古自治区(16.1%),最低的是北京市(3.5%)。结论为了遏制耐多药肺结核,需要尽快提高耐多药肺结核规范化治疗管理的覆盖率,通过规范化治疗来治愈耐多药肺结核患者,以控制耐多药肺结核的传染源从而降低疫情。在开展耐多药肺结核控制的同时,不可降低普通肺结核治疗管理的质量。Objective To understand the prevalence of drug resistant tuberculosis （TB） in China and provide scientific evidence for the development of TB prevention and control strategy. Methods The analysis was conducted on the data of three national TB epidemiological surveys conducted in the mainland of China in 1990,2000 and 2010 to learn about the change trend of initial drug resistance and acquired drug resistance to different anti TB drugs and compare the differences in drug resistant rate and multidrug resistant（MDR） rate in 12 provinces. Results The analysis indicated that the initial resistance to isoniazid and streptomycin showed an upward trend （ P 〈 0.01 ）. The initial resistant rates to ethambutol and sodium pararninosalicylate were higher in 1990 and 2010 but lower in 2000 （ P 〈 0.01 ）. The initial resistant rate and acquired resistance rate to rifampicin were lower in 1990 and 2010 but higher in 2000（P 〈 0.01 ）. The initial resistant rate and acquired resistant rate to protionamide declined significantly in 2000 compared with 1990 （ P 〈 0.01 ）. The drug resistance surveillance in 12 provinces indicated that the initial drug resistant rate was highest in Liaoning（42. 1% ） and lowest in Shanghai（ 14. 5% ）. The acquired resistant rate was highest in Heilongjiang（67.7% ） and lowest in Shanghai （27. 5% ）. The overall resistant rate was highest in Inner Mongolia（44. 8% ） and lowest in Shanghai（ 18. 0% ）. the initial MDR rate was highest in Liaoning（ 10. 4% ） and lowest in Hubei（2. 1% ）. The acquired MDR rate was highest in Inner Mongolia（36. 8% ） and lowest in Xinjiang（7.9% ）. The overall MDR rate was highest in Inner Mongolia（ 16. 1% ） and lowest in Beijing （ 3.5% ）. Conclusion It is necessary to increase the coverage of standardized treatment and management MDR TB to stop the spread of MDR TB. Meanwhile the treatment and management of non drug resistant TB should not be neglected.

关 键 词：耐药 肺结核 耐药监测 流调 

分 类 号：R181.3[医药卫生—流行病学]