台灣肺結核防治與第一線用藥抗藥性的趨勢分析之探討

Drug Resistance Rates of The First Line for Mycobacterium Tuberculosis and Control in Taiwan

黃薇方(Wei-Fang Huang)

指導教授 ： 蔡東榮

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2010年)

摘要

研究背景與動機 :台灣推展結核病防治工作已逾半世紀，似乎認為已經降低肺結核病例，事實上會由於資源不足的情況下，而造成更難以防治的抗藥性問題增加，面臨了高度挑戰。所以值得對於肺結核菌株進行抗藥性趨勢之分析。
研究目的 :探討近年來肺結核菌株產生抗藥性情況及對目前肺結核防治之相關問題。
材料與方法 :本研究係探討2003至2007年,收集的結核菌株委外檢驗中心之第一線抗結核菌藥物(ethambutol、isoniazid、rifampin及streptomycin)抗藥性情形。
結果 : 2003~2007 年共7753株肺結核確定病菌，發現產生抗藥性的比率是有逐年下降的趨勢。對Ethambutol 產生抗藥性為 4.3%， Isoniazid 為19.6%，Rifampin 為 4.6% 及 Streptomycin 13.9%.
而抗藥性與區域間，除了Ethambutol產生抗藥性以中部地區較北部及南部高外,其他皆無顯著性差異。
結論 :肺結核菌株對於第一線肺結核用藥的抗藥性是逐年下降,這趨勢也許要歸功於防治人員徹底實施防疫工作, 全面落實結核病直接觀察治療（都治，DOTS）計畫。而日後預防多重抗藥性結核比率增加, 也是進一步根除結核病的重要策略。

關鍵字

肺結核 ； 都治計畫

並列摘要

Background:
For a half century thought that we had defeated tuberculosis, The fact is that tuberculosis is getting worse, as complacency and lack of adequate tools and funding fuel the disease and the spread of disease and the spread of drug resistance. Drug resistant tuberculosis is the wake-up call, it is an airborne epidemic of increasingly untreatable disease.
Objective:
1. Rate of the resistance to the drug of bacterial strain of tuberculosis in recent year appears.
2. To analyze tuberculosis at present and prevent and cure the discussion of relevant problems.
Materials ＆ Methods:
From January 2003 through December 2007, a total of 7753 isolates of M.tuberculosis by the reference laboratory.
Testing of resistance to anti-tuberculosis agents, including ethambutol, isoniazid, rifampin and streptomycin, was performed using the proportional method.
Results:
Significant decreasing trends in rates of resistance to Ethambutol, Isoniazid, Rifampin and Streptomycin of the 4 first-line agents were observed among 7753 M.tuberculosis isolates from 2003 through 2007.Among these 7753 isolates,the drug resistance rate of Ethambutol was 4.3%, Isoniazid was 19.6%,Rifampin was 4.6% and Streptomycin was 13.9%.
Conclusion:
The remaining high prevalence of multidrug-resistant tuberculosis during a trend decreasing drug resistance are alarming. Continuous surveillance of isolates of M.tuberculosis is importance to identify multidrug-resistant tuberculosis,especially in patients who have a history of tuberculosis and have received prior anti-tuberculosis treatment.

並列關鍵字

Drug Resistance Mycobacterium tuberculosis ； tuberculosis ； infectious disease ； TB isolates

參考文獻

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