福建省结核病耐药监测报告  

Tuberculosis drug resistance surveillance report in Fujian province

作　　者：陈求扬[1,2] 林淑芳[1,2] 梁庆福[1,2] 魏淑贞[1,2] 赵永[1,2] 林建[1,2] 郑金凤[1,2] 

机构地区：[1]福建省疾病预防控制中心结核病预防控制科 [2]福建省医科大学公卫学院教学基地,福州350001

出　　处：《中国防痨杂志》2013年第7期511-515,共5页Chinese Journal of Antituberculosis

基　　金：福建省自然科学基金(2010J01116);中国全球基金结核病项目对本项监测工作给予了大力资助

摘　　要：目的获得福建省结核病耐药状况,评价结核病控制效果,为制订结核病控制对策提供依据。方法采用分层整群抽样,选取30个县(市、区)作为监测点,对调查期间新登记的痰涂片阳性(简称"涂阳")肺结核患者进行痰分离培养,每个监测点入选初治涂阳患者41例,共计划入选初治涂阳患者1230例,复治涂阳患者全部纳入。采用比例法对异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)、氧氟沙星(Ofx)、卡那霉素(Km)进行耐药性检测。结果实际共入选患者1579例(初治1223例、复治356例)。其中,污染率为2.3%(36/1579),涂阳培阴率3.9%(61/1579);进行药敏试验1452例,鉴定为结核分枝杆菌复合群1389例,初治患者占79.8%(1109/1389),复治患者占20.2%(280/1389)。总体耐药率24.0%(333/1389),耐多药率5.7%(79/1389),广泛耐药率0.1%(1/1389),其中初始耐药率为20.7%(230/1109),初始耐多药率为3.2%(35/1109),获得性耐药率为36.8%(103/280),获得性耐多药率为15.7%(44/280),获得性广泛耐药率0.4%(1/280)。共发现耐药谱型41种,包括单耐药6种、多耐药24种、耐多药11种(含广泛耐药1种)。结论福建省结核病耐药水平较低,但耐药谱呈多态性和复杂性,今后要进一步加强耐药结核病的防治工作。Objective To understand the drug resistant status of tuberculosis in Fujian province, evaluate the effect of TB control, and provide evidence base for TB control policy development. Methods 30 counties were selected for TB survey sites by stratified cluster sampling method, all the newly registered smear positive cases during investigation received sputum culture examination, we plan to enroll a total of 1230 new cases of smear positive, 41 new cases in each site and all retreatment patients. The drug susceptibility testing of H,R, S, E, Ofx and Km were performed by proportion method. Results We enrolled a total of 1579 patients（1223 new cases and 356 retreatment cases）,of which, 2.3% （36/1579）was contaminated, the culture negative rate of smear positive patients was 3.9%（61/1579）;1452 cases were performed DST, and 1389 cases were identified as MTBC, new and retreat- ment cases accounting for 79.8%（1109/1389）and 20. 2% （280/1389）, respectively. The total drug resistant rate was 24. 0 % （333/1389）, the rate of multi-drug resistance（MI）R）was 5.7 % （79/1389）, the extensively drug resistant （XDR）rate was 0. 1% （1/1389）. The primary drug resistant rate was 20.7% （230/1109）, the primary MDR rate was 3.2%（35/1109）, the acquired drug resistant rate was 36.8% （103/280）, the acquired MDR rate was 15.7% （44/280）, the acquired XDR rate was 0. 4% （1/280）. We found 41 patterns of drug resistant MTBC spectrum, inclu- ding 6 patterns of mono-drug resistance, 24 patterns of resistance to 2 or more drugs but not MDR, and 11 MDR （comprising 1 patter of XDR）patterns. Conclusion The drug resistant tuberculosis in Fujian province is in a low level, but the resistance spectrum is diverse and complex, therefore, we need to further strengthen the drug resistant TB control work.

关 键 词：结核 肺 药物疗法 抗药性 细菌 药物监测 福建省 

分 类 号：R52[医药卫生—内科学]