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目的调查各级结防机构、结核病专科医院和综合医院二线抗结核药物(second-line antituberculosis drugs,SLD)的使用情况,为国家进一步制定合理使用SLD的相关政策提供资料。方法采用分层目的抽样,按照我国东、中、西的地理位置分布,东、中、西部各抽取4个省,共抽取12个省,各省所有地市和县都参与调查。对各级结核病防治机构、结核病专科医院、综合医院和乡镇卫生院(以下总称为“医疗、结防机构”)进行问卷调查,并将调查问卷进行汇总分析。结果调查4782个机构,72.6%的机构使用了SLD。省市县乡各级医疗、结防机构,使用SLD的比例依次降低,分别为:省级87.0%,地市级83.4%,县区级72.0%,乡镇级70.3%。不同类型的机构使用SLD的比例也不相同,结核病防治所设在结核、胸、肺科医院以及定点医院(98.7%)、结核病医院和有结核病科的专科病院(100%)、综合医院(99.4%)较高。疾病预防控制中心(简称“CDC”)内设结核病防治所(科)较低(22.9%)。不同的SLD使用的比例也不相同,丁胺卡那霉素(49.6%)、氧氟沙星(42.3%)、左氧氟沙星(66.2%)和环丙沙星(39.5%)使用的比例较高。仅有92家(1.9%)医疗、结防机构做一线抗结核药物的药物敏感性试验。影响SLD使用的因素有:地区、机构类型、是否有结核病门诊和病房、结核病床位数、是否做痰涂片、是否做痰培养(P均<0.001)和患者涂阳率(P<0.05)等。药物敏感性试验不是使用SLD的影响因素(P=0.771)。结论SLD在各级结防、医疗机构使用很普遍,不同级别、不同类型的机构以及不同SLD的使用存在较大差异,而药物敏感性试验很少开展。国家应制定有关合理使用SLD的政策,促进SLD药物敏感性试验的开展。
Objective To investigate the use of second-line antituberculosis drugs (SLD) at all levels of TB prevention and control institutions, TB hospitals and general hospitals and provide information for the government to further formulate relevant policies on the rational use of SLD. Methods The stratified purpose sampling was adopted. According to the geographical distribution of East, Central and Western China, 4 provinces were selected from each of the eastern, central and western regions, 12 provinces were selected, and all prefectures and counties in each province participated in the survey. TB control institutions at all levels, TB hospitals, general hospitals and township hospitals (hereinafter collectively referred to as “medical institutions, prevention and treatment institutions”) conducted a survey, and the questionnaire for a pooled analysis. Outcome survey 4782 institutions, 72.6% of institutions use SLD. The proportions of medical, prevention and treatment institutions and SLDs in cities, counties, and cities and townships in all provinces decreased from 87.0% at provincial level to 83.4% at prefectural level, with 72.0% at county level and 70.3% at township level. Tuberculosis, thoracic and pulmonary hospitals and designated hospitals (98.7%), tuberculosis hospitals and specialist hospitals with tuberculosis (100%), general hospitals (99.4 %) Higher. The Centers for Disease Control and Prevention (“CDC”) has a lower level of TB prevention and treatment (22.9%). Different SLDs used different proportions, with a higher proportion of amikacin (49.6%), ofloxacin (42.3%), levofloxacin (66.2%) and ciprofloxacin (39.5%). Only 92 (1.9%) medical and anti-tuberculosis institutions did first-line anti-TB drug susceptibility testing. The factors influencing the use of SLD are: district, type of institution, presence of tuberculosis clinic and ward, number of tuberculosis beds, sputum smear, sputum culture (P <0.001) and smear positive rate (P <0.05) . Drug susceptibility testing is not an influencing factor for the use of SLD (P = 0.771). Conclusions SLD is widely used in the prevention and treatment of all kinds of diseases in hospitals and clinics. There are great differences in the use of SLDs at different levels, different types of institutions and different types of SLDs. However, drug sensitivity tests are rarely conducted. Countries should develop policies on the rational use of SLD to promote the development of SLD drug susceptibility testing.