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目的获得福建省结核病耐药状况,评价结核病控制效果,为制订结核病控制对策提供依据。方法采用分层整群抽样,选取30个县(市、区)作为监测点,对调查期间新登记的痰涂片阳性(简称“涂阳”)肺结核患者进行痰分离培养,每个监测点入选初治涂阳患者41例,共计划入选初治涂阳患者1230例,复治涂阳患者全部纳入。采用比例法对异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)、氧氟沙星(Ofx)、卡那霉素(Km)进行耐药性检测。结果实际共入选患者1579例(初治1223例、复治356例)。其中,污染率为2.3%(36/1579),涂阳培阴率3.9%(61/1579);进行药敏试验1452例,鉴定为结核分枝杆菌复合群1389例,初治患者占79.8%(1109/1389),复治患者占20.2%(280/1389)。总体耐药率24.0%(333/1389),耐多药率5.7%(79/1389),广泛耐药率0.1%(1/1389),其中初始耐药率为20.7%(230/1109),初始耐多药率为3.2%(35/1109),获得性耐药率为36.8%(103/280),获得性耐多药率为15.7%(44/280),获得性广泛耐药率0.4%(1/280)。共发现耐药谱型41种,包括单耐药6种、多耐药24种、耐多药11种(含广泛耐药1种)。结论福建省结核病耐药水平较低,但耐药谱呈多态性和复杂性,今后要进一步加强耐药结核病的防治工作。
Objective To obtain the status of tuberculosis drug resistance in Fujian Province and to evaluate the control effect of tuberculosis so as to provide the basis for formulating the control strategy of tuberculosis. Methods Stratified cluster sampling was used to select 30 counties (cities, districts) as monitoring points for the sputum smear-positive sputum smear positive (“smear-positive”) newly registered sputum smear culture during the investigation. Each monitoring 41 cases of newly diagnosed smear-positive patients were enrolled, a total of 1230 cases of newly diagnosed smear-positive patients and 12 cases of smear-positive smear-positive patients were enrolled. The ratio of isoniazid (H), rifampin (R), streptomycin (S), ethambutol (E), ofxofloxacin (Ofx), kanamycin Drug testing. Results The actual total of 1579 patients were enrolled (initial treatment of 1223 cases, 356 cases of retreatment). Among them, the pollution rate was 2.3% (36/1579), smear-negative peanut rate was 3.9% (61/1579); drug-sensitive test of 1452 cases identified as Mycobacterium tuberculosis complex of 1389 cases, the initial treatment of patients accounted for 79.8% (1109/1389), retreatment patients accounted for 20.2% (280/1389). The overall drug resistance rate was 24.0% (333/1389), MDR rate was 5.7% (79/1389), and the rate of extensive drug resistance was 0.1% (1/1389). The initial drug resistance rate was 20.7% (230/1109) The initial MDR rates were 3.2% (35/1109), acquired drug resistance rates were 36.8% (103/280), acquired MDR rates were 15.7% (44/280), and acquired DSR rates were 0.4 % (1/280). A total of 41 types of drug resistance spectrum were found, including 6 single drug resistance, 24 multi-drug resistance and 11 multi-drug resistance (including 1 broad-spectrum drug resistance). Conclusion The level of drug resistance of tuberculosis in Fujian province is low, but the spectrum of drug resistance is polymorphic and complicated. In the future, the prevention and cure of drug-resistant TB should be further strengthened.