新发涂阳肺结核患者就诊与诊断延误对产生耐药的影响  

The effect of patient delay and diagnosis delay on drug-resistance in new smear positive tuberculosis

作　　者：王倪[1] 周林[1] 白丽琼 许卫国[4] 何金戈[5] 徐晓玉[6] 成诗明[2] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心患者关怀部,北京102206 [2]中国疾病预防控制中心主任办公室,北京102206 [3]湖南省结核病防治所结核病控制科 [4]江苏省疾病预防控制中心慢性传染病防制科 [5]四川省疾病预防控制中心结防所 [6]上海交通大学医学院公共卫生学院

出　　处：《中国防痨杂志》2014年第2期81-85,共5页Chinese Journal of Antituberculosis

基　　金：中国全球基金结核病项目实施性研究（08-009）

摘　　要：目的了解新发涂阳肺结核患者就诊与诊断延误对产生耐药的影响，为制定耐药结核病防治策略提供科学依据。方法采取典型调查的方法。在我国东、中、西部各选1个省，每省各选择1个县作为研究现场；采用课题组编制的《新发涂阳肺结核患者诊疗过程调查表》对研究现场结核病防治机构2010年59月登记发现的329例初治涂阳肺结核患者进行面对面的问卷调查，共收回329份，有效率100．0％。对329人份痰标本进行痰培养检查，并对痰培养阳性的标本进行包括异烟肼、利福平、乙胺丁醇和链霉素4种抗结核药物的药敏试验；使用非参数检验比较耐药患者和非耐药患者的延误时间，以P〈0．05为差异有统计学意义。结果患者痰培养阳性率为88．8％（292／329），痰培养阳性的标本中总耐药率为12．7％（37／292），耐多药率为2．8％（8／292）。耐药患者总延误、就诊延误和诊断延误分别为37d（8～465d）、15d（0～462d）和12d（0～218d）；非耐药患者总延误、就诊延误和诊断延误分别为38d（1～597d）、16d（0～594d）和10d（0～429d），耐药与非耐药患者在总延误、就诊延误和诊断延误水平上差异均无统计学意义（Z值分别为0．377、0．142、0．069，P值均〈0．05）。结论延误与耐药发生问没有直接的因果关系。Objective To understand the effect of patient delay and diagnosis delay of new smear positive tuberculosis （TB） cases and drug resistance, and to provide scientific evidence for the development of drug-resistant TB control and prevention strategies. Methods The typical survey method was adopted and 3 counties were selected from 3 provinces located in the eastern, middle and western areas in China. Three hundred and twenty-nine new smear positive TB patients registered during May 2010 to September 2010 were investigated with the question naire of the process of diagnosis and treatment of new smear positive patients designed by the research group, and 329 questionnaires were received with 100.0% effective rate. Sputum culture examination was applied for the sputum samples from 329 patients, drug susceptibility test of INH, RFP, EMB and S was used for those with positive sputum culture samples. Non-parametric test was used to compare the delay between drug-resistant patients and non-drug resistant patients. 0.05 was set as the criteria of statistical significance. Results The positive rate of sputum culture was 88.8%（ 292/329 ）, the total drug-resistance rate was 12.7% （37/292）, and the multidrug re- sistance （MDR） rate was 2.8% （8/292）. Total delay, patient delay and diagnosis delay for drug resistant patients were 37 d （8-465 d）, 15 d （0-462 d） and 12 d （0--218 d） respectively, and 38 d （1--597 d）, 16 d （0--594 d） and 10 d （0-429 d） for non-resistant patients. There was no significant difference between drug-resistance and non-drug resistance on 3 kinds of delay （Z=0. 377, 0. 142, 0. 069, P〈0.05）. Conclusion There is no inevitable relationship between delay and drug-resistance.

关 键 词：结核 肺 诊断 误诊 抗药性 细菌 

分 类 号：R521[医药卫生—内科学]