摘要目的 分析山东省MTB耐药流行状况,并与1997年的监测结果相比较,为制定耐药结核病控制措施提供科学依据.方法 对2004年10月至2011年12月山东省结核病耐药监测哨点送检的5916例涂阳肺结核痰培养阳性标本进行一线抗结核药物敏感性试验,有检测结果的为5542例,其中男4198例,女1344例；年龄15 ～ 92岁,平均(51±20)岁,≤29岁组1304例,30 ～ 59岁组2106例,≥60岁组2132例；初治4332例(占78.2％),复治1210例(占21.8％).各组间率的比较采用x2检验.结果 山东省MTB总耐药率为19.4％(1075/5542),较1997年的总耐药率(23.4％,288/1229)有明显下降(x2=10.193,P＜0.01).单耐药率、耐多药率和多耐药率分别为11.3％(629/5542)、3.7％(203/5542)和4.4％ (243/5542)；初治患者耐药率为19.0％(822/4332),其中62.7％(515/822)的初治耐药患者为单耐药；复治患者耐药率为20.9％ (253/1210),其中54.9％(139/253)的复治耐药患者为耐多药或多耐药；耐药患者单耐药率为58.5％(629/1075),初治患者占76.5％(822/1075);初治患者耐多药率为2.9％ (124/4332),复治患者耐多药率为6.5％(79/1210),差异有统计学意义(x2 =36.032,P ＜0.01)；男性与女性的耐药率分别为19.9％(834/4198)和17.9％(241/1344),初治耐药率分别为19.5％(641/3287)和17.3％(181/1045),复治耐药率分别为21.2％(193/911)和20.1％(60/299),差异均无统计学意义(x2值为0.170 ～2.452,均P＞0.05).结论 近年山东省的耐药结核病控制工作成效显著,MTB耐药以初治患者为主,因此耐药结核病控制工作应注重早期发现、有效治疗和加强管理,以控制耐药MTB的传播.

abstractsObjective To analyze the present epidemic status of drug-resistant Mycobacterium tuberculosis (MTB) in Shandong Province of China,as compared with findings of survey for drug-resistant MTB in 1997,and therefore to provide valuable data for making the current control policy of drug-resistant MTB.Methods From October 2004 to December 2011,the culture positive sputum samples of all 5916 new registered sputum smear-positive TB patients at the county-level TB dispensaries were tested for drug susceptibility.Finally 5542 cases with test results were included in the analysis.Of the total cases,4198 were male and 1344 were female.The age range of the patients were 15 to 92 years old and the average age was (51 ±20) years old,among whom,1304 were ≤ 29 years old,2106 were from 30 to 59 years old and 2132 were ≥ 60 years old.Of all the cases,4332 (78.2％) only received initial treatment and 1210 (21.8％) received retreatment.The SPSS 13.0 was used for statistical analysis and x2 test was used to compare category,gender,and age groups of patients.Results The total drug resistance (TDR) rate was 19.4％ (1075/5542),which was lower than 23.4％ (288/1229) in 1997 in Shandong Province (x2 =10.193,P ＜ 0.01).The rates of single drug resistance (SDR),multidrug resistance (MDR) and poly-drug resistance (PDR) were 11.3％ (629/5542),3.7％ (203/5542) and 4.4％ (243/5542),respectively.The TDR rate in patients with initial treatment was 19.0％ (822/4332),and 62.7％(515/822) of which was SDR.The TDR rate of patients with retreatment was 20.9％ (253/1210),and 54.9％ (139/253) of which tended to be MDR or PDR.Among TDR patients,those with initial treatment accounted for 76.5％ (822/1075) and SDR patients accounted for 58.5％ (629/1075).The MDR rate of patients with initial treatment was 2.9％ (124/4332) and the rate of patients with retreatment was 6.5％(79/1210),the differences being significant (x2 =36.032,P ＜0.01).The TDR rate,initial TDR rate,and retreatment TDR rate in males were 19.9％ (834/4198),19.5％ (641/3287),and 21.2％ (193/911),respectively,as compared to 17.9％ (241/1344),17.3％ (181/1045),and 20.1％ (60/299) in females,the differences being not significant (x2 =0.170-2.452,P ＞ 0.05).Conclusions The drug-resistant TB control work in Shandong Province has made great achievements in recent years.However,patients with initial treatment were more likely to have drug-resistant MTB.Therefore the future control work should focus on early detection,effective treatment and management to control the spread of drugresistant MTB.