NEJM：中国耐药性结核流行趋势不容乐观

男丁格尔

                               
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多药耐药结核既往诊治有关统计

关于中国耐药性结核流行病学的有效信息往往是基于局部区域性调查取得的，在2007年，中国疾控中心的研究者Yanlin Zhao博士等人对中国耐药性结核进行了全国范围的调研，中国的耐药性结核的流行趋势非常严峻，且面临治疗不当的局面。相关论文发表于国际权威杂志NEJM2012年6月7日在线版。
研究者用集群随机抽样方式评估了公共卫生系统登记的中国结核人群中耐药性结核患者的比例，并检测了其对一线抗结核药物如异烟肼，利福平，乙胺丁醇，链霉素以及二线药物如氧氟沙星，卡那霉素等的抗性。然后，研究者根据调查结果和有关结核发生的文献记录对耐药性结核的发生率进行了评估，并对患者主诉及访谈记录进行研究以鉴别耐药性相关因素。
研究人员发现在3037例初诊结核患者和892例已经治疗的患者中，分别有5.7% (95% 置信区间 [CI], 4.5 至 7.0) 和 25.6% (95% CI, 21.5 至 29.8)的患者为耐药性(MDR)结核（定义为至少对异烟肼和利福平产生抗性）。在所有患者中，大约有四分之一对异烟肼，利福平或两者均产生耐药性，大约十分之一的患者为耐药性结核患者。大约8%的MDR结核患者为广谱耐药性(XDR)结核（定义为至少对异烟肼，利福平，氧氟沙星，卡寻霉素产生耐药性）。2007年，总共有110 000例(95% CI, 97,000 至 130,000)新发MDR结核病例以及8200例(95% CI, 7200 至 9700)新发XDR结核病例。大部分MDR和XDR结核患者为原发性感染。经多次既往治疗并在结核病医院接受最后一次治疗的患者往往具有最高的MDR结核的危险（校正后优势比，13.3; 95% CI, 3.9至 46.0）。在226例经既往治疗的MDR结核患者中，43.8%并没有完成最后一次治疗；大部分患者在医院系统接受治疗。而在公共卫生系统完成治疗后大部分上述患者的结核病症继续发展。
研究人员由此得出结论，中国的耐药性结核的流行趋势非常严峻，无论是在公共卫生系统还是医院系统，MDR结核均面临着不当治疗的局面，特别是在结核病医院，这种现象更加严重；然而，大部分的此类病例呈现原始性感染特点。
National survey of drug-resistant tuberculosis in China.

N Engl J Med 2012;36623:2161-70

Zhao Y Xu S Wang L Chin DP Wang S Jiang G Xia H Zhou Y Li Q Ou X Pang Y Song Y Zhao B Zhang H He G Guo J Wang Y

Chinese Center for Disease Control and Prevention, and Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.

Abstract
The available information on the epidemic of drug-resistant tuberculosis in China is based on local or regional surveys. In 2007, we carried out a national survey of drug-resistant tuberculosis in China. We estimated the proportion of tuberculosis cases in China that were resistant to drugs by means of cluster-randomized sampling of tuberculosis cases in the public health system and testing for resistance to the first-line antituberculosis drugs isoniazid, rifampin, ethambutol, and streptomycin and the second-line drugs ofloxacin and kanamycin. We used the results from this survey and published estimates of the incidence of tuberculosis to estimate the incidence of drug-resistant tuberculosis. Information from patient interviews was used to identify factors linked to drug resistance. Among 3037 patients with new cases of tuberculosis and 892 with previously treated cases, 5.7% (95% confidence interval [CI], 4.5 to 7.0) and 25.6% (95% CI, 21.5 to 29.8), respectively, had multidrug-resistant (MDR) tuberculosis (defined as disease that was resistant to at least isoniazid and rifampin). Among all patients with tuberculosis, approximately 1 of 4 had disease that was resistant to isoniazid, rifampin, or both, and 1 of 10 had MDR tuberculosis. Approximately 8% of the patients with MDR tuberculosis had extensively drug-resistant (XDR) tuberculosis (defined as disease that was resistant to at least isoniazid, rifampin, ofloxacin, and kanamycin). In 2007, there were 110,000 incident cases (95% CI, 97,000 to 130,000) of MDR tuberculosis and 8200 incident cases (95% CI, 7200 to 9700) of XDR tuberculosis. Most cases of MDR and XDR tuberculosis resulted from primary transmission. Patients with multiple previous treatments who had received their last treatment in a tuberculosis hospital had the highest risk of MDR tuberculosis (adjusted odds ratio, 13.3; 95% CI, 3.9 to 46.0). Among 226 previously treated patients with MDR tuberculosis, 43.8% had not completed their last treatment; most had been treated in the hospital system. Among those who had completed treatment, tuberculosis developed again in most of the patients after their treatment in the public health system. China has a serious epidemic of drug-resistant tuberculosis. MDR tuberculosis is linked to inadequate treatment in both the public health system and the hospital system, especially tuberculosis hospitals; however, primary transmission accounts for most cases. (Funded by the Chinese Ministry of Health.).

转自：丁香园

yhy8562243

我们这里是结核高发区，看了此资料后确是深有感触。谢谢！

西藏清清

我们也是高发区，严峻啊，昨天卫生部创卫专家组也是这样讲，要高度重视啊，谢谢版主在论坛上发文，让大家重视。

月季花开

深有感触，结核病的治疗任重道远。对结核病的宣传尚需加强。
       “你我共同参与，消除结核危害”