【摘要】 目的分析山东省10年来痰涂片阳性肺结核患者初、复治的耐药情况,为制定和完善防控措施提供依据。方法收集2004年2月1日至2014年2月1日间山东省37个结核病医院患者经痰培养及菌群鉴定后9861例标本分离出结核分枝杆菌作为纳入对象,其中新发患者9229例,复治患者632例,运用WHO/IUATLD推荐的比例法药敏试验来测定结核分枝杆菌分离株对利福平(RFP)、异烟肼(INH)、链霉素(SM)、乙胺丁醇(EMS)等4种常用一线抗结核药的敏感性。结果患者的平均年龄为(47.72±20.02)岁,其中40~60岁患有结核病的例数最多;新发涂阳肺结核患者与复治涂阳肺结核患者的总耐药率为22.50%(2219/9861),全耐药率为2.47%(244/9861),初治患者耐药率为21.28%(1964/9229),复治患者耐药率为40.35%(255/632);总耐多药率为6.62%(653/9861),初治患者耐多药率为5.70%(526/9229),复治患者耐多药率为20.09%(127/632),复治患者耐多药率高于初治患者。结论山东省肺结核耐药情况严重,特别是面对耐多药、广泛耐药结核的情况,需进一步采取更全面、更积极的干预措施来降低肺结核的耐药率。更多还原

【Abstract】 Objective: To analyze the anti-TB drug resistance condition of Shandong province in the past 10 years,with regard to new smear positive cases and new registered retreatment smear positive cases,and to provide the basis for the next step to develop and improve the prevention and control measures. Methods: 9861 isolated mycobacterium tuberculosis cases were collected during February 1,2004 to 2014 in Shandong province from 137 tuberculosis hospital after sputum culture and bacteria identification specimens were included in the surveillance,concluding 9229 new cases,and 632 retreatment patients. By applying the proportion method of drug sensitive test that WHO/IUATLD recommend to determine sensitivity of the mycobacterium tuberculosis isolates to four kinds of commonly used first-line anti-TB drugs of rifampicin(RFP) and isoniazid(INH),streptomycin(SM) and ethambutol(EMS). Results: The patients’ average age was(47. 72 ± 20. 02) years,with 20 years interval grouping,40 to 60 years old group was the most suffering from tuberculosis,including Shandong province new smearpositive pulmonary tuberculosis patients with recurrent smear-positive pulmonary tuberculosis patients with total resistance was22. 50%(2219/9861),the total resistant rate of 2. 47%(244/9861),the initial treatment patients resistant rate was21. 28%(1964/9229),recurrent patients resistant rate was 40. 35%(255/632); The total multi-drug resistant rate was 6.62%(653/9861) and the initial treatment patients 5. 71%(526/9229). The multidrug resistance rate of recurrent patients was 20. 09%(127/632),and the multidrug rate was higher than the initial treatment. Conclusion: The tuberculosis drug resistance situation,especially multi-drug resistant and extensive drug resistance,was serious in Shandong province. Further steps of a more comprehensive and more positive intervention should be takens to reduce the incidence of drug-resistant tuberculosis.更多还原