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背景:泰国曼谷及其邻近的3所监狱。目的:了解执行DOTS策略2年后泰国囚犯涂阳肺结核病例的耐药性及其影响因素。方法:利用横断面研究设计,在2000年5月1日至10月31日间连续收集154例至少有一份阳性痰涂片和一份阳性痰培养结果的肺结核病人。药物敏感性试验由公共卫生部结核病署完成。并利用面对面调查方法取得病人的特征资料。结果:50.6％的研究对象至少对一种药物耐受,其中包括19.5％的耐多药肺结核(MDR-TB)。监狱A、B和C囚犯菌阳肺结核病例中的总体耐药率分别为 52.7％、37.8％和61.5％。与总体耐药(P=0.011)和耐多药(P<0.001)相关的唯一因素是既往抗结核治疗史。结论:在实行DOTS策略2年后,作为反映抗结核治疗质量指标的抗结核药物耐药率仍然很高。应当对泰国监狱目前采用的DOTS策略进行检讨,以减少和预防耐药结核病的发生。
Background: Bangkok, Thailand and its three neighboring prisons. Objective: To understand the drug resistance and its influencing factors of smear-positive pulmonary tuberculosis among Thai prisoners 2 years after DOTS strategy was implemented. METHODS: Using a cross-sectional study design, 154 consecutive patients with at least one positive sputum smear and one positive sputum culture were collected between May 1 and October 31, 2000. Drug susceptibility testing by the Ministry of Public Health TB completed. And use the method of face-to-face survey to obtain the patient’s characteristic data. RESULTS: Fifty-six percent of the study participants tolerated at least one drug, including 19.5% of MDR-TB. The overall drug resistance rates of prisoners with positive bacteria in tuberculosis cases A, B and C were 52.7%, 37.8% and 61.5% respectively. The only factor associated with overall resistance (P = 0.011) and multidrug resistance (P <0.001) was the previous history of anti-TB treatment. CONCLUSIONS: Two years after the DOTS strategy was implemented, the anti-TB drug resistance rate, which is a reflection of the quality of anti-TB treatment, remains high. The DOTS strategy currently used in Thai prisons should be reviewed to reduce and prevent the emergence of drug-resistant TB.