Zhu L, Yang Y-Z, Guan H-Y, Cheng S-M, Jin Y-Y, Tan W-G, Wu Q-F, Liu X-L, Zhao M-G, Lu Z-H, Jia Z-W
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, National Institute of Drug Dependence, Peking University, Beijing.
Shenzhen Chronic Disease Control Centre, Shenzhen.
Int J Tuberc Lung Dis. 2017 Jul 1;21(7):759-765. doi: 10.5588/ijtld.16.0759.
The DOTS strategy has been regarded as the most cost-effective way to stop the spread of tuberculosis (TB) since its launch by the World Health Organization.
To estimate the effects of DOTS by tracking long-term trends in multidrug-resistant TB (MDR-TB).
A retrospective cohort study was conducted from 2000 to 2013 to analyse trends in resistance to anti-tuberculosis drugs and the effect of DOTS-based treatment in Shenzhen, China, using the χ2 test.
An overall MDR-TB rate of 4.2% was observed between 2000 and 2013, with an annual reduction of 0.16%. From 2000 to 2013, trends in resistance to isoniazid (INH), rifampicin (RMP) and MDR-TB declined significantly in new TB patients (P < 0.01), but not in retreatment cases. Sputum smear conversion rates after 2 months of treatment decreased significantly, in particular after 2007, in new and retreatment cases.
INH and RMP resistance and MDR-TB rates declined significantly, suggesting that DOTS-based programmes were successful in reducing drug resistance in new cases but not in retreatment cases. The decreasing sputum smear conversion rates may have been due to an increase in the number of migrants. These two findings suggest that TB is unlikely to be completely eliminated by 2050 in Shenzhen.
自世界卫生组织推出以来，直接观察短程治疗（DOTS）策略一直被视为阻止结核病传播的最具成本效益的方法。
通过追踪耐多药结核病（MDR-TB）的长期趋势来评估DOTS的效果。
采用χ2检验，对2000年至2013年期间中国深圳的抗结核药物耐药趋势及基于DOTS的治疗效果进行回顾性队列研究。
2000年至2013年期间，总体耐多药结核病率为4.2%，年降幅为0.16%。2000年至2013年，新结核病患者对异烟肼（INH）、利福平（RMP）和耐多药结核病的耐药趋势显著下降（P<0.01），但复治病例未见下降。治疗2个月后的痰涂片转阴率显著下降，特别是2007年后，新病例和复治病例均如此。
异烟肼和利福平耐药率及耐多药结核病率显著下降，表明基于DOTS的方案在降低新病例的耐药性方面取得了成功，但在复治病例中未成功。痰涂片转阴率下降可能是由于移民数量增加。这两个发现表明，深圳到2050年不太可能完全消除结核病。
