National Survey of Drug-Resistant Tuberculosis in China
National Survey of Drug-Resistant Tuberculosis in China
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DOI：
10.1056/nejmoa1108789
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发表时间：
2012-06-07
影响因子：
158.5
通讯作者：
Wang, Yu
中科院分区：
文献类型：
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作者：
Zhao, Yanlin;Xu, Shaofa;Wang, Yu
中国耐药结核病流行的现有信息是基于地方或区域调查。2007年，我们进行了一项全国耐药结核病调查在中国。方法我们估计在中国的结核病病例的比例是耐药的公共卫生系统的结核病病例的整群随机抽样和耐药检测一线抗结核药物异烟肼，利福平，乙胺丁醇，链霉素和二线药物氧氟沙星和卡那霉素。我们使用这项调查的结果和发表的结核病发病率估计来估计耐药结核病的发病率。从病人访谈中获得的信息被用来确定与耐药性相关的因素。在3037例新发结核病患者和892例既往治疗过的结核病患者中，（95%置信区间[CI]，4.5 - 7.0）和25.6%（95% CI，21.5 - 29.8）分别患有多药耐药（MDR）结核病（定义为至少对异烟肼和利福平耐药的疾病）。在所有结核病患者中，约1/4的患者对异烟肼、利福平或两者均耐药，1/10的患者患有MDR结核病。大约8%的MDR结核病患者患有广泛耐药（XDR）结核病（定义为至少对异烟肼、利福平、氧氟沙星和卡那霉素耐药的疾病）。在2007年，有110，000例MDR结核病（95% CI，97，000 - 130，000）和8200例XDR结核病（95% CI，7200 - 9700）。大多数MDR和XDR结核病例是由原发性传播引起的。在结核病医院接受最后一次治疗的既往多次治疗患者发生MDR结核病的风险最高（校正比值比，13.3; 95%CI，3.9 - 46.0）。在226例既往接受过治疗的耐多药结核病患者中，43.8%的患者未完成末次治疗;大多数患者在医院系统接受过治疗。在那些谁已经完成治疗，结核病再次发展，在他们的治疗后，在公共卫生system. CONCLUSION中国有一个严重的耐药结核病的流行。耐多药结核病与公共卫生系统和医院系统，特别是结核病医院的治疗不足有关;然而，原发性传播占大多数病例。（由中国卫生部资助）
BACKGROUNDThe 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.METHODSWe 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.RESULTSAmong 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.CONCLUSIONSChina 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.)