2006-2014年深圳市652例耐多药结核病患者的发现及治疗与管理  

Analysis of case detection, treatment and management of 652 patients with multi-drug resistant pulmonary tuberculosis in Shenzhen City from 2006 to 2014

作　　者：管红云[1] 谭卫国[1] 杨应周[2] 吴清芳[1] 车晓玲[1] 李明珍[1] 

机构地区：[1]深圳市慢性病防治中心结核病防治科,518020 [2]深圳市慢性病防治中心中心办公室,518020

出　　处：《中国防痨杂志》2017年第5期518-524,共7页Chinese Journal of Antituberculosis

基　　金：“十二五”国家科技重大专项（2012ZX10004-903）;广东省医学科学技术研究基金（A2015050）;中国全球基金结核病项目（CHN-S10-G14-T）

摘　　要：目的分析深圳市耐多药结核病（MDR-TB）患者的发现及治疗与管理情况，为进一步完善我市MDR-TB防控策略提供科学依据。方法收集2006年10月至2014年12月深圳市登记的8015例涂阳肺结核患者的耐药筛查、诊断、治疗和管理等相关报表、登记本和病案资料，分析MDR-TB患者的发现和纳入治疗情况、治疗6个月末和12个月末痰菌阴转情况、24个月末的治疗转归情况。结果8015例涂阳肺结核患者中有6898株为结核分枝杆菌复合群，共确诊652例MDR-TB患者，MDR-TB检出率为9．45％（652／6898）。其中初治患者和复治患者的MDR-TB检出率分别为4．14％（232／5600）和32．36％（420／1298），复治患者的MDR-TB检出率明显高于初治患者，差异有统计学意义（χ2=980．13，P〈0．05）。MDR-TB患者纳入治疗率为31．75％（207／652），未纳人治疗的主要原因是返乡治疗（150例，33．71％）、其他各种原因不能接受治疗（80例，17．98％）和失访（63例，14．16％）。207例接受治疗的MDR-TB患者中，6个月末痰涂片和痰培养阴转率分别为82．61％（171／207）、80．68％（167／207）；第12个月末痰涂片和痰培养阴转率分别为71．98％（149／207）、70．05％（145／207），24个月末治疗成功率为66．18％（137／207）。结论深圳市MDR-TB发现覆盖面较广，治疗成功率维持在较高水平，但纳入治疗率偏低。流动人口MDR-TB患者治疗管理的影响因素很多，管理难度较大。Objective To analyze the case detection, treatment and management of muhidrug-resistant pul- monary tuberculosis （MDR-TB） in Shenzhen City in 2006-2014, and to provide references for the development of MDR-TB control and prevention strategy. Methods The report data, medical records and registration record about drug-resistance screening, diagnosis, treatment and management of 8015 smear positive TB patients registered between October 2006 and December 2014 were collected, the data of case detection, treatment, sputum conversion status after 6 and 12 months＇ , and treatment outcomes after 24 months were analyzed. Results Sputum samples from 8015 smear positive cases were cultured and 6898 isolates of Mycobacterium tuberculosis were identified, 652 patients were diagnosed as MDR-TB, and the overall detection rate was 9.45% （652/6898）. The MDR-TB detec- tion rates among new smear positive and retreated TB cases were 4.14% （232/5600） and 32.36% （420/1298） respectively. MDR-TB detection rate of retreated TB cases was significantly higher than that of new smear positive TB cases （χ2 =980. 13, P〈0. 05）. The registered for treatment rate was 31.75% （207/652）. The main reasons for not registered for treatment were returning to their hometown （150, 33.71%）, unable to receive treatment for various reasons （80, 17.98%） and lost to follow-up （63, 14.16%）. Two hundred and seven MDR-TB patients received treatment, and the sputum smear conversion rate and sputum culture conversion rates were 82. 61% （171/207） and 80.68% （167/207） respectively after 6 months, which were 71.98% （149/207） and 70. 05% （145/207） respectively after 12 months＇ treatment, the treatment success rate of MDR-TB was 66.18% （137/207）after 24 months＇ treatment. Conclusion The coverage of MDR-TB case finding is extensive in Shenzhen, and the treatment success rate stays at a higher level, but the proportion of treatment is relatively low. There are many in- fluence factors for the treatment of MD

关 键 词：结核 肺 结核 抗多种药物性 多种药物疗法 卫生服务管理 治疗结果 

分 类 号：R181.3[医药卫生—流行病学]