Drug-resistant tuberculosis in Shanghai, China, 2000-2006: prevalence, trends and risk factors.
Drug-resistant tuberculosis in Shanghai, China, 2000-2006: prevalence, trends and risk factors.
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发表时间：
2009-02
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通讯作者：
Xin Shen;K. Deriemer;Zheng’an Yuan;Mei Shen;Z. Xia;Xiao-hong Gui;Lili Wang;Q. Gao;J. Mei
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作者：
Xin Shen;K. Deriemer;Zheng’an Yuan;Mei Shen;Z. Xia;Xiao-hong Gui;Lili Wang;Q. Gao;J. Mei
方法2000-2006年在上海市开展了结核病耐药监测研究。目的了解上海市耐药结核病（TB）的流行趋势和危险因素。设计对上海市2000-2006年报告的肺结核患者进行回顾性研究。结果8419例肺结核患者中，16.6%对一线抗结核药物耐药，4.0%耐多药。2000-2003年结核病患者对一线抗结核药物耐药率和MDR率均明显上升（P=0.01和P<0.01）。在2004年改进结核病控制方案后，耐药性上升的趋势得到遏制。年龄30-59岁、城市移民和居住在上海市区与新病例中任何一线药物的耐药性和MDR独立相关，而年龄30-59岁、城市移民与既往治疗病例中任何一线药物的耐药性和MDR独立相关。结论耐药结核病和耐多药结核病对上海市结核病控制工作构成挑战。应持续改进病例管理，包括DOTS和适当的治疗方案，以防止在这种情况下耐药结核病的进一步传播和发展。
SETTING During 2000-2006, a regional anti-tuberculosis drug resistance surveillance study was conducted in Shanghai, China. OBJECTIVE To determine the prevalence, trends and risk factors for drug-resistant tuberculosis (TB) in Shanghai, China. DESIGN A retrospective study of all pulmonary TB patients reported in Shanghai during 2000-2006 was conducted. RESULTS Of 8419 pulmonary TB patients, 16.6% had resistance to any first-line anti-tuberculosis drug and 4.0% had multidrug resistance (MDR). The percentage of TB patients with resistance to any first-line anti-tuberculosis drug and MDR significantly increased during 2000-2003 (P=0.01 and P<0.01, respectively). After improvements in the TB control programme in 2004, the increasing trend in drug resistance was contained. Age 30-59 years, being an urban migrant and residence in an urban area of Shanghai were independently associated with resistance to any first-line drug and MDR in new cases, while age 30-59 years and being an urban migrant were independently associated with resistance to any first-line drug and MDR in previously treated cases. CONCLUSIONS Drug-resistant TB and MDR-TB pose a challenge for TB control in Shanghai. Improved case management, including DOTS and appropriate treatment regimens, should be sustained to prevent further transmission and development of drug-resistant TB in this setting.