北京市耐多药肺结核控制5年结果分析  

Evaluation of multidrug-resistant tuberculosis control in 5 years in Beijing

作　　者：洪峰[1] 高志东[2] 李波[2] 孙闪华[2] 赵鑫[2] 

机构地区：[1]北京结核病控制研究所办公室,100035 [2]北京结核病控制研究所防控科,100035

出　　处：《中国防痨杂志》2013年第9期706-710,共5页Chinese Journal of Antituberculosis

基　　金：首都卫生发展科研专项(首发2011-1012-01)

摘　　要：目的调查北京市疑似耐多药肺结核(multidrug-resistant tuberculosis,MDR-TB)患者中抗结核药物耐药谱,评估国产药物组方化疗MDR-TB患者的疗效,探索适合北京市的MDR-TB控制策略。方法2008年4月至2013年3月,全市各结核病防治(简称"结防")机构对21 651例活动性肺结核患者治疗管理中,通过痰培养发现的1124例疑似MDR-TB患者。对885例属结核分枝杆菌复合群的疑似MDR-TB患者的阳性培养物开展抗结核药物药敏试验。确诊的277例MDR-TB患者,进行国产药物组方化疗,根据患者情况分类选择治疗管理方式,观察其不良反应和治疗效果。结果5年间,属结核分枝杆菌复合群的疑似MDR-TB患者中,284例MDR-TB患者(7例为治疗期间重做药敏,实际发现为277例患者)占32.1%(284/885),对一、二线药物全敏感者占21.4%(133/620)。对277例MDR-TB患者采用分类治疗管理的方法,其中在结防机构使用二线MDR-TB方案治疗者占45.9%(127/277),其中59.8%(76/127)的患者出现不良反应,已获得转归信息患者的治愈率为63.4%(59/93);维持原方案治疗及转诊专科医院的比率分别为17.7%(49/277)和13.0%(36/277)。结论及时对发现的疑似MDR-TB患者进行一、二线抗结核药物药敏试验非常必要。北京市MDR-TB患者分类治疗管理的效果较为理想。Objective To describe drug resistance spectrums of tuberculosis（TB） isolates from multidrug-re- sistant tuberculosis （MDR-TB） suspects, to assess the treatment effect of domestic drug group of MDR-TB and to explore the MDR-TB control strategy which is applicable in Beijing. Methods During the period of April 2008 to March 2013, 1124 MDR-TB suspects were detected by sputum culture in 21 651 patients with active tuberculosis. Drug susceptibility test （DST） was applied to the microbe-positive cultural substanfes of 885 MDR-TB suspects with strains of Mycobacterium tuberculosis complex, 277 diagnosed MDR-TB patients were treated by domestic drug prescription, and the treatment management methods were selected according to the patient＇s situation, and the ad- verse effect and therapeutic effect were observed. Results During the 5 years of implementation, MDR-TB pa- tients accounted for 32.1% （284/885）of the MDR-TB suspects with Mycobacterium tuberculosis strains. The propor tion of the strains which were sensitive to both the first and the second-line drugs were 21.4%（133/620）. Because 7 MDR-TB patients conducted DST again during treatment, there were actually 277 MDR-TB patients detected. Classified management methods were applied to the 277 MDR-TB cases, 127 cases （45.9%） were treated with the second-line drugs in TB control institutes, among whom 76 cases（59.8%） had side effects. The cure rate of the 93 MDR-TB patients who had treatment outcomes were 63.4% （59/93）. The proportions of MDR-TB patients main- tained the original treatment regimen or referred to a specialized hospital were 17. 7% （ 49/277 ） and 13. 0% （36/277）. Conclusion It is essential for the suspected MDR-TB to conduct DST timely to, get early detection of MDR-TB cases and to develop an appropriate treatment regimen to control the spread of multi-drug resistant TB. The classified management for MDR-TB patients gets the ideal effect.

关 键 词：结核 肺 预防和控制 结核 肺 药物疗法 抗药性 多种 细菌 微生物敏感性试验 临床方案 北京市 

分 类 号：R521[医药卫生—内科学]