上海口岸结核分枝杆菌一线抗结核药物耐药情况调查

目的了解上海口岸结核分枝杆菌一线抗结核药物的耐药水平,为制定口岸传染性结核病防治策略提供依据,也为直接督导下的短程化疗(directly observed treatment short course,DOT)提供用药指导。方法针对2009年12月—2011年12月上海口岸出入境人群中胸部影像学诊断疑似肺结核患者,采集其连续3d的晨痰分离培养结核分枝杆菌,用MGIT960培养法检测其一线抗结核药物(链霉素、异烟肼、利福平、乙胺丁醇、吡嗪酰胺)的耐药情况。结果共分离到结核分枝杆菌复合群38株,其中有11株至少对一种一线抗结核药物耐药,总耐药率为29.0%(11/38),接近国内报道数据31.7%,显著高于国际中位数12.2%(χ2=8.777,P=0.003)及香港地区14.4%(χ2=6.433,P=0.011)的耐药水平。单耐一种药物的耐药率为23.7%(9/38),其中单耐异烟肼5.3%(2/38);单耐链霉素5.3%(2/38);单耐吡嗪酰胺13.2%(5/38),未检出单耐利福平和单耐乙胺丁醇耐药株。耐多种药物的耐药率为5.3%(2/38),其中多耐药结核(mulitdrug resistanceTB,MDR-TB)2.6%(1/38),异烟肼合并乙胺丁醇和吡嗪酰胺耐药率2.6%(1/38)。结论上海口岸面临耐药性肺结核病传播风险。其一线抗结核药物总耐药率接近我国国内报道水平,但高于我国香港地区和国际中位数水平。单药物耐药特征为高吡嗪酰胺耐药率、低利福平和乙胺丁醇耐药率。多耐药率接近国内外报道水平。采用目前的DOT方案仍应有效。有必要建立口岸特色的传染性结核病防治措施,有效地维护公共卫生安全。

Surveillance on first-line anti-tuberculosis drug resistance at Shanghai Port

Objective To investigate the first-line drug-resistant TB rate at Shanghai Port,and provide DST data and other evidence decision-making for directly observed treatment（DOT） as well as TB quarantine at Chinese ports.Methods From Dec.2009 to Dec.2011,international travel applicants who were suspected of TB patients by abnormal chest radiological exam atShanghai port were enrolled in this study.Their sputum specimen were smeared and cultured for 3 consecutive days in the early morning for mycobacterium tuberculosis isolation.MGIT 960 method was used to detect first-line anti-tuberculosis drug resistance（streptomycin,rifampicin,isoniazid,ethambutol,pyrazinamide）.Results There were 38 active tuberculosis applicants whose sputum specimen culture were positive for MTB Complex.Of which,11 isolated strains were resistant to at least one first line anti-tuberculosis drugs.The total drug-resistant TB rate was 29.0%（11/38） which was similar to those of other five provinces in China（31.7%）,and was higher than that of Hong Kong（14.4%）and global median（12.2%）.There were 9 isolated strains（23.7%） which were only resistant to one anti-tuberculosis drug.Among them,2 strains（5.3%）were resistant to streptomycin,2 strains（5.3%）were resistant to isoniazid,five strains（13.2%）were resistant to pyrazinamide.There was 1 MDR（2.6%）and 1 isolate（2.6%）resistant to 3 drugs（ethambutol,isoniazid,pyrazinamide）.No rifampicin and ethambutol single-resistant strain was found in this study.Conclusion The risk of drug resistance does exist in Shanghai Port currently.The overall resistance rate is above the average in other provinces in the mainland China,but higher than Hongkong and international median.DOT regimen recommended by WHO is suitable for Shanghai Port..It is necessary to enhance the surveillance on managing and treating these infectious TB to ensure their health and safety for international travel applicants.