新密市DOTS执行下耐多药结核病监测分析

目的 了解DOTS执行下河南省新密市耐药结核病流行状态。方法 根据《全国结核病耐药性基线调查实施手册》的患者纳入原则，自2007年3月1日至2010年2月28日在新密市连续纳入初、复治涂阳肺结核患者333例（每年分别为100例、135例和98例）,其中初治涂阳患者295例，复治涂阳患者38例。按照《全国结核病耐药性基线调查质量保证手册》的标准，对纳入患者的痰标本进行分离培养和菌型鉴定，剔除污染、未生长和非结核分枝杆菌的标本，共获得296株Mtb菌株用于抗结核药物敏感性试验（其中261株来自初治患者，35株来自复治患者），对收集的菌株进行4种一线抗结核药物（INH、RFP、EMB和S）的耐药监测。结果 3年涂阳肺结核患者总耐药率和耐多药率分别为28.57%（26/91）、30.43%（35/115）、27.78%（25/90）和5.49%（5/91）、7.83%（9/115）、4.44%（4/90）。涂阳肺结核患者分离的86株耐药Mtb中仅耐1种药物（单耐）47株（15.88%，47/296），耐2种药物（双耐）20株（6.76%，20/296），耐3种药物（三耐）12株（4.05%，12/296），耐4种药物（全耐）7株（2.36%，7/296）；同时耐RFP和INH的耐多药菌株18株（6.08%，18/296）。结论 新密市总体耐药水平低于全国平均水平，但3年的耐药水平基本保持一致，需实施更加有效的耐药结核病患者发现和治疗措施，以降低现有的耐药率。

Analysis on multidrug-resistant tuberculosis surveillance under DOTS implementation in Xinmi county

Objective To understand the epidemic of multidrug-resistant tuberculosis(TB) under the DOTS(directly observed treatment short-course)implementation in Xinmi county of Henan province.Methods Accor-ding to the inclusion criteria defined by the guidelines for national drug-resistant tuberculosis baseline survey,a total of 333 cases,including 295 cases of new and 38 cases of retreatment smear positive pulmonary tuberculosis patients,were enrolled successively for multidrug-resistant tuberculosis(MDR-TB) surveillance from March 1,2007 to Fe-bruary 28,2010;100,135 and 98 cases in each year respectively.According to the criteria set by the quality control manual for national drug-resistant tuberculosis baseline survey,sputum culture and strain identification were done for the included patients.All the contaminated samples,those that did not grow and those were not Mycobacterium tuberculosis were ruled out.296 isolated strains were acquired eventually,including 261 strains from new cases and 35 strains from retreatment cases.These strains were performed first line TB drugs(INH,RFP,EMB,S) susceptibility test.Results The overall smear positive drug-resistant rate were 28.57%(26/91),30.43%(35/115),27.78%(25/90)and multidrug-resistant rate were 5.49%(5/91),7.83%(9/115),4.44%(4/90)for 3 years re-spectively.Among the 86 drug-resistant Mtb strains isolated from the smear positive TB patients,47 strains(15.88%,47/296)resisted to one kind of drugs,20 strains(6.76%,20/296)resisted to two kinds of drugs,12 strains(4.05%,12/296)resisted to three kinds of drugs,7 strains(2.36%,7/296) resisted to four kinds of drugs,18 strains(6.08%,18/296) resisted to both RFP and INH.Conclusion The epidemic of MDR-TB was lower than that of the whole country.The epidemic remained in the same level in Xinmi county in the past 3 years.Effective measures to detect and treat drug-resistant TB patients should be taken to reduce the rate of drug-resistant tuberculosis.