2001 至 2005年澳门地区耐药结核病的流行趋势分析

目的分析中国澳门地区2001至2005年结核病的耐药情况。方法选取近5年澳门地区新发结核病患者及复治结核病患者结核分枝杆菌分离株进行4种抗结核药物（异烟肼、利福平、链霉素、乙胺丁醇）的耐药性测定。结果1460株结核分枝杆菌的总耐药率为16．2％（236株），其中初始和获得性耐药率分别为15．0（203／1357）和32．0（33／103）；耐多药率为3．2％（47／1460），其中初始和获得性耐多药率分别为2．3％（31／1357）和15．5％（16／103）；4种抗结核药物的耐药率由高到低依次为异烟肼（11．5％）、链霉素（9．5％）、利福平（3．6％）、乙胺丁醇（2．5％）；耐1种、2种、3种和4种药物的初始耐药率分别为9．9％、2．9％、1．0％和1．2％，获得性耐药率分别为12．6％、3．9％、8．7％和6．8％。近5年新发和复治患者的耐药率没有上升趋势（χ2值分别为0．27和0．03，P均〉0．05）；不同性别和年龄组间初始耐药率的差异无统计学意义（χ2=5．7，P〉0．05）。结论本次流行病学调查结果与1996至1999年澳门地区结核病流行病学调查资料比较，获得性耐药率和获得性耐多药率显著下降，差异有统计学意义（χ2值分别为6．04和7．47，P均〈0．05），但初始耐药率和获得性耐药率高于2004年第3次全球多国耐药监察结果，仍处于高耐药水平，尤其是耐多药率较高的问题，应引起重视。

Epidemiological survey on the trend of drug resistance of Mycobacterium tuberculosis complex in Macao during 2001 to 2005

OBJECTIVE: To analyse the trend of anti-tuberculosis drug resistance in Macao from 2001 to 2005. METHODS: Susceptibility tests of anti-tuberculosis drugs (SM, INH, RFP and EMB) against all M. tuberculosis complex (MTBC) isolates were performed in new cases and previous treated cases. RESULTS: The total resistant rate of 1460 isolates was 16.2%; the initial drug resistant rate was 15% and the acquired drug resistant rate was 32%. The multi-drug resistant (MDR) rate was 3.2%, in which the initial and the acquired MDR rates were 2.3% and 15.5%, respectively. Any resistance to INH, SM, RFP and EMB was 11.5%, 9.5%, 3.6% and 2.5% respectively. The resistant rates to 1, 2, 3 and 4 drugs were 9.9%, 2.9%, 1.0% and 1.2% in new cases and 12.6%, 3.9%, 8.7% and 6.8% in previous treated cases. There was no significant increase in drug resistance of new cases and treated cases in last 5 recent years (chi(2) = 0.27, chi(2) = 0.03, all P > 0.05). The initial drug resistant rate did not show significant difference (chi(2) = 5.7, P > 0.05) among different sex and age groups. CONCLUSIONS: Compared to the previous data, the acquired drug resistant rate and the acquired MDR rate were significantly lower (chi(2) = 6.04, chi(2) = 7.47, all P < 0.05). But the initial drug resistant rate and acquired drug resistant rate were still higher than the report of No.3 of WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance in 2004. More attention should be paid to the high incidence of MDR tuberculosis.