河南省第二轮结核病耐药监测及耐药趋势研究

目的掌握河南省2001年结核病耐药水平,评价1996—2001年耐药趋势,为结核病控制决策提供参考。方法采用整群抽样随机抽取30个监测点,各监测点连续入选43个新涂阳病人,同时纳入其间的复治涂阳病例。痰涂片镜检采用Ziehl-Neelsen法,培养用L-J培养基。对培养阳性的菌株用TCH和PNB进行菌型鉴定。对四种抗结核药物:INH,RFP,EMB和SM采用比例法进行药敏试验。结果总耐药率、初始耐药率及获得性耐药率分别为35.3%,29.8%和60.8%;总MDR率、初始MDR率和获得性MDR率分别为:12.9%,7.8%和36.6%。2001年河南省总耐药率、初始耐药率及总MDR率、初始MDR率较之1996年有所下降,但获得性耐药率及获得性MDR率变化不明显。结论河南省结核病耐药率仍处于全国5个监测省份之首和全球前几位,应引起高度重视。同时提示河南省需采取得力措施落实DOTS策略。

The study on the second round surveillance of drug resistance in tuberculosis and its trends in Henan, China

Objective To determine the drug resistance prevalence in 2001 and its trends from 1996 to 2001 in Henan,as well as to evaluate the implementation of the tuberculosis control program and to provide reference evidence for policy makers of tuberculosis control.Methods 30 centers were randomly selected using clustering sampling method.The intake of patients in every center was successively,that is,all smear positive cases(patients with or without treatment history) in the intake period were enrolled,until the 43 new cases in each center were completed.Sputum smear microscope test was carried out using the Ziehl-Neelsen technique.All smear positive sputum samples were cultured using Loewenstein-Jensen medium,and identification of M.TB of all culture positive strains was carried out using TCH and PNB.Proportion method was used for drug susceptibility tests for the four anti-tuberculosis drugs,isoniazid,rifampicin,streptomycin and ethambutol.Results The total,initial and acquired drug resistance rate are 35.3%,29.8% and 60.8% respectively.And the total,initial and acquired Multi-drug resistance(MDR) rate are 12.9%,7.8% and 36.6% respectively.Compared with the drug resistance prevalence in 1996,the total,initial drug resistance rate,as well as the total and initial MDR rate in 2001 decreased significantly,while the acquired drug resistance rate and its MDR rate did not show significant change.Conclusion The drug resistance prevalence in Henan is still the highest out of the five provinces surveyed in China,and one out of the highest countries in the world,which should be paid much attention.It also suggests that sound tuberculosis control strategies(DOTS) should be carried out in Henan.