Viljanen M K, Vyshnevskiy B I, Otten T F, Vyshnevskaya E, Marjamäki M, Soini H, Laippala P J, Vasilyef A V
National Public Health Institute, Department in Turku, Finland.
Eur J Clin Microbiol Infect Dis. 1998 Mar;17(3):177-83. doi: 10.1007/BF01691114.
The morbidity, mortality, and relapse rates of tuberculosis have increased in the Russian Federation since 1991. Increased drug resistance may be one reason for the weakened efficacy of local tuberculosis treatments. Laboratory data on tuberculosis resistance were collected from a survey area that included two republics and seven other administrative regions (oblasts) with a total population of more than 14 million. Susceptibility data from 1991 through 1994 were available from all nine regions; data on resistance to individual drugs and data from 1984 through 1994 were available from the Leningrad region and the city of St. Petersburg. From 1991 through 1994. the annual notification rate of tuberculosis increased in the survey area by 53.7% (from 25.1 to 38.6 cases per 100000 inhabitants), tuberculosis mortality doubled (from 4.4 to 9.2 deaths per 100000), and primary resistance to at least one drug increased from 17% (95% CI, 14.9-19.9) to 24% (95% CI, 22.2.-25.8). The prevalence of primary resistance to at least isoniazid and rifampin (multidrug resistance) was 5.1% in the Leningrad region in 1992 through 1994. The proportion of pulmonary isolates with secondary multidrug resistance increased from 21.6% (95% CI 7.9-25.3%) in the period 1984-1994 to 33% (95% CI 29.7-36.3%) in 1989-1994. Even if these figures are biased upwards because of selection, it can be concluded that secondary resistance to tuberculosis drugs was already prevalent in northwestern Russia ten years ago. Since then, a distinct shift towards multidrug resistance has occurred. The lower prevalence of primary multidrug resistance raises hopes that the resistance problem can be controlled with properly designed and monitored therapeutic measures.
自1991年以来，俄罗斯联邦结核病的发病率、死亡率和复发率均有所上升。耐药性增加可能是当地结核病治疗效果减弱的一个原因。结核病耐药性的实验室数据来自一个调查地区，该地区包括两个共和国和其他七个行政区（州），总人口超过1400万。1991年至1994年期间所有九个地区的药敏数据均可用；列宁格勒州和圣彼得堡市可提供对个别药物的耐药性数据以及1984年至1994年的数据。1991年至1994年期间，调查地区结核病的年度报告率上升了53.7%（从每10万居民25.1例增至38.6例），结核病死亡率翻了一番（从每10万居民4.4例死亡增至9.2例），对至少一种药物的原发耐药性从17%（95%CI，14.9 - 19.9）增至24%（95%CI，22.2 - 25.8）。1992年至1994年期间，列宁格勒州对至少异烟肼和利福平的原发耐药率（多重耐药）为5.1%。肺部分离株继发多重耐药的比例从1984 - 1994年期间的21.6%（95%CI 7.9 - 25.3%）增至1989 - 1994年期间的33%（95%CI 29.7 - 36.3%）。即使这些数字因选择因素而被高估，也可以得出结论，十年前俄罗斯西北部结核病药物的继发耐药已经普遍存在。自那时以来，已出现明显向多重耐药的转变。原发多重耐药率较低让人希望耐药问题能够通过精心设计和监测的治疗措施得到控制。
