上海口岸结核分枝杆菌一线抗结核药物耐药情况调查

    王健，方筠，叶魏，陆晔，张晓航，韩晓辉，贾哲甫，鞠志英，周娴，章琪

    上海国际旅行卫生保健中心，上海 200335

    摘要：目的了解上海口岸结核分枝杆菌一线抗结核药物的耐药水平，为制定口岸传染性结核病防治策略提供依据，也为直接督导下的短程化疗（directlyobserved treatment short course ，DOT）提供用药指导。方法针对2009年12月—2011年12月上海口岸出入境人群中胸部影像学诊断疑似肺结核患者，采集其连续3d的晨痰分离培养结核分枝杆菌，用MGIT960培养法检测其一线抗结核药物（链霉素、异烟肼、利福平、乙胺丁醇、吡嗪酰胺）的耐药情况。结果共分离到结核分枝杆菌复合群38株，其中有11株至少对一种一线抗结核药物耐药，总耐药率为29.0%(11/38)，接近国内报道数据31.7%,显著高于国际中位数12.2%（χ2= 8.777，P = 0.003）及香港地区14.4%（χ2 = 6.433，P =0.011）的耐药水平。单耐一种药物的耐药率为23.7%（9/38），其中单耐异烟肼5.3%(2/38)；单耐链霉素5.3%(2/38)；单耐吡嗪酰胺13.2%(5/38)，未检出单耐利福平和单耐乙胺丁醇耐药株。耐多种药物的耐药率为5.3%（2/38），其中多耐药结核(mulitdrugresistance TB, MDR-TB）2.6%(1/38)，异烟肼合并乙胺丁醇和吡嗪酰胺耐药率2.6%(1/38)。结论上海口岸面临耐药性肺结核病传播风险。其一线抗结核药物总耐药率接近我国国内报道水平，但高于我国香港地区和国际中位数水平。单药物耐药特征为高吡嗪酰胺耐药率、低利福平和乙胺丁醇耐药率。多耐药率接近国内外报道水平。采用目前的DOT方案仍应有效。有必要建立口岸特色的传染性结核病防治措施，有效地维护公共卫生安全。

   关键词：传染性结核病；结核分枝杆菌复合群；抗结核药物敏感性试验；多耐药结核病；口岸；卫生监管

    中图分类号：R521 R183.3　文献标识码：B

    Surveillance on first-line anti-tuberculosisdrug resistance at  Shanghai Port

    WANG Jian, FANG Yun, YE Wei, LU Ye, ZHANGXiao-hang, HAN Xiao-hui, JIA Ze-fu,

    JU Zhi-ying, ZHOU Xian, ZHANG Qi

    Shanghai International Travel HealthcareCenter, Shanghai 200335,China

    Abstract:   Objective  To investigate the first-line drug-resistant TB rate at Shanghai Port, and provide DST data and other evidencedecision-making for directly observed treatment (DOT) as wellas  TB  quarantine at  Chinese  ports. Methods   From Dec. 2009 to Dec. 2011, international travel applicants who were suspected of TB patientsby abnormal chest radiological exam atShanghai port were enrolledin this study.  Their sputum specimen were smeared andcultured  for 3 consecutive days in the early morning formycobacterium tuberculosis isolation.  MGIT 960 method wasused to detect first-line anti-tuberculosis drug resistance(streptomycin, rifampicin, isoniazid, ethambutol,pyrazinamide).  Results   There were 38 activetuberculosis applicants whose sputum specimen culture were positivefor MTB Complex. Of which, 11  isolated strains were resistantto at least one first line anti-tuberculosis drugs. The totaldrug-resistant TB rate was 29.0% (11/38) which was  similar tothose of other five provinces in China (31.7%), and was higher than that of Hong Kong(14.4%)and global median(12.2%).Therewere 9 isolated strains(23.7%) which were only resistant to oneanti-tuberculosis drug. Among them, 2 strains（5.3%） were resistantto streptomycin, 2 strains（5.3%） were resistant to isoniazid，fivestrains（13.2%）were resistant to pyrazinamide. There was 1 MDR（2.6%）and 1 isolate（2.6%）resistant to 3 drugs(ethambutol , isoniazid,pyrazinamide). No rifampicin and ethambutol single-resistant strainwas found in this study.   Conclusion   Therisk of drug resistance does exist in Shanghai Portcurrently.    The overall resistance rate is abovethe average in other provinces in the mainland China, but higherthan Hongkong and international median. DOT regimen recommended by WHO is suitable for Shanghai Port. . It is necessaryto enhance the surveillance on managing and treating theseinfectious TB to ensure their health and safety for internationaltravel applicants.

    Key words:   Infectioustuberculosis； Mycobacterium tuberculosis complex； Drug susceptivetests； MDR-TB； Port; Surveillance

    《中国国境卫生检疫杂志》