四川省多次抗痨治疗经历的结核病患者耐药现状研究  

Study on the drug resistance among treatment-experienced tuberculosis patients in Sichuan Province

作　　者：何金戈[1] 龙波[1] 常壤丹[1] 李婷[1] 宁柱[2] 邓建平[2] 赵琦[3] 吴建林[1] 

机构地区：[1]四川省疾病预防控制中心结核病预防控制所,四川成都610041 [2]自贡市疾病预防控制中心结核病预防控制所,四川自贡643000 [3]复旦大学公共卫生学院流行病学教研室,上海200032

出　　处：《现代预防医学》2014年第12期2252-2255,共4页Modern Preventive Medicine

摘　　要：目的了解四川省有多次抗痨治疗史结核病患者的耐药现状。方法在四川省选择正在开展全球基金耐药项目的1个地市,随机抽取2个县作为研究现场。以各区、县2011年4月1日至2011年10月31日在结核病防治所登记的、有多次抗痨治疗史的肺结核患者为研究对象进行问卷调查,同时查阅病史记录、收集痰标本、培养分离菌株,使用比例法进行一线抗结核药物的药敏检测。结果纳入81名研究对象,培养获得的49株结核分枝杆菌中,总耐药率为81.63%(40/49),耐多药结核病(MDR-TB)发生率为42.86%(21/49)。使用过非标准治疗方案的调查对象耐药发生率(86.67%)明显高于未使用过的调查对象(79.41%)(χ2=14.107,P<0.05),第一次治疗标准、规则的调查对象耐药发生率(79.54%)和MDR发生率(36.36%)均明显低于第一次治疗非标准、规则的调查对象(100.0%、100.0%)。结论有多次抗痨治疗经历的结核病患者耐药、MDR的发生率高,强化首诊标准化、规则治疗是减少耐药发生的重要举措。Objective The study aimed to assess the current status on drug resistance among patients with tuberculosis after multiple anti-tuberculosis treatments in Sichuan Province. Methods Two counties in a city in Sichuan in which a China Global Fund-spon- sored drug-resistance project was conducting were randomly selected as the sites of investigation. Patients with tuberculosis who were registered at the district or county tuberculosis centers between April 1~ and October 31~ of 2011 and had experienced multiple anti-tuberculosis treatments were surveyed by questionnaires. Medical histories of the patients were also retrieved, and sputum specimens were collected for bacterial isolation. Drug susceptibility of the strains against first-line anti-tuberculosis drugs was de- termined by using the proportion method. Results 81 research subjects were included in the study, from which 49 strains of My- cobacterium tuberculosis were isolated. Overall drug resistance rate of the strains was 81.63% （40/49）, and the incidence of mul- tidrug resistant tuberculosis （MDR-TB） was 42.86% （21/49）. The incidence of drug resistance among subjects who were given non-standard treatments （86.67%） was significantly higher than that among subjects who were treated with standard procedures （79.41%） （Х^2=14.107, P〈0.05）; and the incidences of drug resistance and MDR among subjects who received a standard and regu- lated initial treatment （79.54% and 36.36%, respectively） were significantly lower than those among subjects who were given a non-standard and non-regulated initial treatment （100%, 100%）. Conclusion The incidences of drug resistance and MDR among treatment-experienced tuberculosis patients are high. Reinforcement of the standardization of the initial diagnosis and the compliance of regulated treatments are important measures for the reduction of the incidence of drug resistance.

关 键 词：结核 耐药 耐多药 治疗经历 

分 类 号：R183.3[医药卫生—流行病学]