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重庆市六区(县)耐多药肺结核患者发现治疗现状分析
引用本文:刘英,曹奕,张文,成君.重庆市六区(县)耐多药肺结核患者发现治疗现状分析[J].中国防痨通讯,2013,35(10):808-811.
作者姓名:刘英  曹奕  张文  成君
作者单位:400050.重庆市结核病防治所区县防治科(刘英、曹奕、张文);中国疾病预防控制中心结核病预防控制中心(成君)
基金项目:“十一五”国家科技重大专项(2008ZX10003-007)
摘    要:目的通过分析重庆市6个区(县)的耐多药肺结核患者发现和治疗情况,为探索重庆市的耐药结核病防治模式提供科学依据。方法对三峡库区6个区(县)收集的1189 例涂阳肺结核患者进行传统药敏试验,其中1015例新涂阳肺结核患者,174例耐多药肺结核高危人群;根据耐多药肺结核患者发现和治疗数据,分析不同类型肺结核患者中的耐多药肺结核检出率、菌株运输情况及确诊耐多药肺结核患者未纳入治疗的原因。结果1189 例涂阳肺结核患者中,84 例(7.1%) 确诊为耐多药肺结核。不同性别耐多药检出率比较,男性为6.9%(61/883)、女性为7.5%(23/306),不同性别间差异无统计学意义(χ2=0.07,P>0.05);不同年龄组间耐多药检出率比较,≤20岁、>20~岁、41~岁、61~80岁分别为6.9%(7/102)、8.7%(25/286)、7.8%(39/499)、4.3%(13/302),不同年龄组间差异无统计学意义(χ2=2.15,P>0.05);从患者分类来看,新涂阳肺结核患者的耐多药检出率为3.6%(37/1015),高危人群检出率为27.0%(47/174),差异有统计学意义(χ2=123.5,P<0.01)。耐多药可疑患者留痰至开展药敏试验的总体时间间隔平均为90.9d (66.0~118.9d)。84例确诊耐多药肺结核患者中,22例纳入治疗,纳入治疗率为26.2%(22/84);62例未纳入治疗,经济困难为未纳入治疗的第一位原因,其患者占41.9%(26/62)。结论重庆市耐多药肺结核发现的筛查对象应为高危人群,应就近设立定点医院耐多药肺结核规范化诊疗管理点,并落实医保政策,解决患者的诊疗费用,以保障患者进行规范化治疗。

关 键 词:结核  肺/药物疗法  抗药性    多种    细菌  重庆市  
收稿时间:2013-07-12

The analysis of current situation on the detection and treatment of MDR-TB patients in six districts and counties of Chongqing city
LIU Ying,CAO Yi,ZHANG Wen,CHENG Jun.The analysis of current situation on the detection and treatment of MDR-TB patients in six districts and counties of Chongqing city[J].The Journal of The Chinese Antituberculosis Association,2013,35(10):808-811.
Authors:LIU Ying  CAO Yi  ZHANG Wen  CHENG Jun
Institution:Department for TB Prevention and Treatment of Counties,Chongqing Institute of TB Prevention and Treatment, Chongqing 400050, China
Abstract:Objective For the purpose of providing scientific evidence for the prevention and treatment model of drug-resistant TB, we analyzed the current situation on the detection and treatment of MDR-TB patients of 6 dis- tricts and counties in Chongqing. Methods All 1189 smear-positive patients were collected from the 6 districts and counties of the 3 Gorges reservoir region.1015 cases were new smear-positive TB patients and 174 cases were from high risk patients of MDR-TB. The drug-susceptibility test results, transporting situation and the causes who were not included in the treatment were analyzed. Results Among 1189 smear-positive patients,84 cases(7, 1%)were diagnosed as MDR-TB. Comparing multidrug-resistant detection rate in different gender, the male was 6.9% (61/883), the female was 7.5% (23/306); there was no statistical differences between genders with the detection rate of multidrug-resistant(χ2=0.07, P〉0.05). Comparing different age groups,≤20 years,〉20 years- ,41 years- and 61-80 years old were 6.9% (7/102), 8. 7% (25/286), 7.8% (39/499), 4. 3% (13/302) respectively; there was no statistical differences between different age groups with the detection rate of multidrug-resistant(χ2 =2.15, P〈0. 05). From the point of patient classification, new smear-positive pulmonary tuberculosis patients with multi- drug-resistant detection rate was 3.6% (37/1015), the detection rate from high risk population was 27.0% (47/174), the difference was statistically significant (χ2= 123.5,P〈0.01). The overall time interval (d) for sus- pected multi-drug resistant patients between leave phlegm to carry out drug sensitive test was an average of 90. 9 d (66.0-118.9 d). In 84 cases of multi-drug resistant TB diagnosis, 22 cases received treatment, the treatment rate was 26.2% (22/84) ; and 62 cases were out of treatment and economic difficulties was the priority reason accounting for 41.9 %(26/62). Conclusion The screening for MDR-TB should target at the high risk population in Chongqing city, we should set up standardized diagnosis and treatment management points of MDR-TB nearby designated TB hospitals, and carry out medical insurance policy, addressing patient clinic costs, in order to ensure patients' s standardized treatment.
Keywords:Tuberculosis  pulmonary/drug therapy  Drug resistance  multiple  bacterial  Chongqing city
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