Hu Yi, Mathema Barun, Wang Weibing, Hoffner Sven, Kreiswirth Barry, Xu Biao
Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
Microb Drug Resist. 2008 Sep;14(3):227-32. doi: 10.1089/mdr.2008.0823.
This study aimed to describe the prevalence of drug-resistant tuberculosis (TB) among pulmonary TB patients in rural China and to determine the extent of multidrug-resistant TB (MDR-TB) circulating in areas with varied duration of Directly Observed Treatment, Short Course (DOTS) implementation.
A cross-sectional study was conducted in two rural counties in eastern China: Deqing with over 10 years' DOTS implementation and Guanyun under its second year of DOTS. The subjects were all culture-positive pulmonary TB patients newly diagnosed or re-treated during 12 months of 2004-2005. The proportion method was used for drug susceptibility testing.
Among the 399 subjects, 283 were new TB cases and 116 were previously treated. The rates of overall resistance (i.e., resistance to at least one drug) in new cases were 50.4% (67) and 63.4% (95), respectively, in Deqing and Guanyun (p = 0.028), and 67.3% (33) and 83.6% (56), respectively, in previously treated cases (p = 0.0410). The rates of MDR-TB in new cases were 3.8% (5) in Deqing and 14.7% (22) in Guanyun (p = 0.0018), and 16.3% (8) and 34.3% (23) in previously treated cases (p = 0.0305).
Newly diagnosed and previously treated TB patients from the short-term DOTS-covered county were at higher risk for overall drug-resistance TB and MDR-TB. Standardized diagnosis and treatment strategies for drug-resistant TB are urgently needed for effective control of MDR-TB in rural China.
本研究旨在描述中国农村肺结核患者中耐药结核病（TB）的患病率，并确定在不同直接督导下短程化疗（DOTS）实施时长的地区中耐多药结核病（MDR-TB）的传播程度。
在中国东部两个农村县进行了一项横断面研究：德清实施DOTS超过10年，灌云处于DOTS实施的第二年。研究对象为2004 - 2005年12个月期间新诊断或再治疗的所有痰培养阳性肺结核患者。采用比例法进行药敏试验。
在399名研究对象中，283例为新发病例，116例为既往治疗病例。德清新发病例的总耐药率（即对至少一种药物耐药）分别为50.4%（67例）和灌云的63.4%（95例）（p = 0.028），既往治疗病例分别为67.3%（33例）和83.6%（56例）（p = 0.0410）。德清新发病例的耐多药结核病率为3.8%（5例），灌云为14.7%（22例）（p = 0.0018），既往治疗病例分别为16.3%（8例）和34.3%（23例）（p = 0.0305）。
来自短期实施DOTS县的新诊断和既往治疗的肺结核患者发生总体耐药结核病和耐多药结核病的风险更高。为有效控制中国农村的耐多药结核病，迫切需要针对耐药结核病的标准化诊断和治疗策略。
