文章摘要
邵 燕,宋红焕,李国莉,杨丹丹,刘 巧,陈 诚,竺丽梅,许卫国,陆 伟.江苏省2010年结核病耐药流行病学调查[J].南京医科大学学报,2013,(2):282~285
江苏省2010年结核病耐药流行病学调查
Epidemiology of drug-resistant Mycobacterium tuberculosis strains circulating in Jiangsu Province in 2010
投稿时间:2012-06-29  
DOI:10.7655/NYDXBNS20130235
中文关键词: 结核    耐药  流行
英文关键词: tuberculosis  lung  drug-resistance  epidemic
基金项目:医学重点学科(LJ201150);江苏省疾病预防控制中心科教兴业工程重点人才(JKRC2011005)
作者单位
邵 燕 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
宋红焕 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
李国莉 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
杨丹丹 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
刘 巧 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
陈 诚 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
竺丽梅 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
许卫国 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
陆 伟 江苏省疾病预防控制中心慢性传染病防治所,江苏 南京 210009 
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中文摘要:
      目的: 分析江苏省结核分枝杆菌耐药谱及耐药结核病的危险因素,为制定结核病预防和控制策略提供科学依据。方法:收集2010年6~7月新登记报告的痰涂阳性的结核病患者痰标本,并经痰涂片检测和痰培养证实。运用WHO/IUATLD推荐的比例法药敏试验测定结核分枝杆菌分离株对4种常用一线抗结核药的敏感性,进行耐药谱分析,并探讨耐药结核病产生的影响因素。结果:收集260株结核分枝杆菌,216株(83.1%)分离自初治患者;44株(16.9%)分离自复治患者。186株(71.5%)对利福平?异烟肼?乙胺丁醇?链霉素4种抗结核病药全敏感;74株(28.5%)对一种或一种以上药物耐药,33株(12.7%)为单耐药菌株,34株(13.1%)同时对异烟肼和利福平耐受,为耐多药菌株,17株(6.5%)对4种一线药全耐受。多因素Logistic回归显示,抗结核治疗史与耐多药发生风险的关联有统计学意义,与初治患者相比,复治患者耐多药发生的风险增加,调整比值比(odds ratio,OR)=3.40 (95%CI:1.42~8.13)。结论:江苏省结核病耐药形势严峻,需加强对初治患者的管理,切实贯彻直接面视下短程化疗策略 (direct observed therapy short course,DOTS),提高结核病患者的治疗依从性和治疗成功率,减少耐药结核发生。
英文摘要:
      Objective:To describe the baseline data and epidemiological characteristics of Mycobacterium tuberculosis (MTB) strains circulating in Jiangsu Province,and to provide policy makers with recommendations for prevention and control of tuberculosis. Methods:Sputum smear-positive tuberculosis patients reported in June and July 2010 were continuously recruited. Diagnosis was further confirmed by sputum culture. Proportional method which was recommended by WHO/IUATLD was used to determine the sensitivity to the four first-line anti- tuberculosis drugs,and we further analyzed the drug resistant spectrum and possible risk factors. Results:Of all the 260 patients,there were 216(83.1%) new cases and 44(16.9%)previously treated ones,with the male-to-female ratio of 2.25∶1. Drug resistant test indicated that 186 (71.5%)strains were sensitive to all the four anti-tuberculosis drugs, including rifampin,isoniazid,ethambutol,streptomycin,while 74 strains were resistant to at least one drug. The total resistance proportion was 28.5% and the MDR (at least resistant to INH and RFP at the same time)proportion was 34(13.1%). Multivariate Logistic regression showed that treatment history was significantly associated with MDR. Compared with the new cases,previously treated ones had 3.40 times risk of MDR,with the adjusted OR of 3.40 (95% CI:1.42-8.13). Conclusion:The high prevalence of drug resistance has been a major challenge for TB control. Prevention and control of drug-resistant tuberculosis should emphasize on the implementation of the DOTS (direct observed therapy) to increase the treatment compliance and treatment success rate and reduce the occurrence of drug resistance tuberculosis.
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