The present paper aims to investigate the prevalence and drug resistance of active pulmonary tuberculosis in entry applicants in Shanghai port, and to provide the directly observed treatment short-course (DOTS) data of foreign applicants with tuberculosis for Chinese Tuberculosis Surveillance System. From January 2010 to August 2011, among 79 465 foreign applicants, 79 were found with active pulmonary tuberculosis by chest X-ray. The prevalence rate (99/100 000) was lower than Chinese population (459/ 100 000). The early morning sputum specimens were collected from these tuberculosis patients for 3 consecutive days for acid-fast smear and culture of Mycobacterium tuberculosis. Twenty-three of them were positive for Mycobacterium tuberculosis complex. Of these 23, nine were resistant to at least one first-line anti-tuberculosis drug, with total resistance rate of 39.1% (9/23). There were 2 streptomycin-resistant isolates (8. 7%), 1 isoniazid-resistant isolate (4. 3%),5 pyrazinamide-resistant isolates (21.7%) and 1rnisolate resistant to three drugs (ethambutol, isoniazid, pyrazinamide) (4.3%). The results suggested that Shanghai port is facing the risk of transmission of active drug-resistant pulmonary tuberculosis. Tt is necessary to enhance the surveillance system to manage and treat these patients effectively.%本文旨在了解上海口岸输入性肺结核病患病率及其对抗结核药物的耐药情况,为直接督导下的短程化疗(DOTS)提供用药指导,也为口岸传染性肺结核病防治策略的制定提供依据.选取2010年1月~2011年8月从上海口岸入境并符合我国入境人员肺结核病监测要求的入境申请者中胸部影像学呈活动性肺结核病表现的人员,采集其连续3 d的晨痰,用浓缩集菌法处理痰液,抗酸染色法显微镜检测痰涂片中的抗酸杆菌,同时分离培养结核分枝杆菌复合群(MTB complex),用MGIT960培养法检测MTB complex对抗结核药物(链霉素、异烟肼、利福平、乙胺丁醇、吡嗪酰胺)的耐药情况,并采集同期人口学资料.在20个月内共监测了入境外籍申请者79 465人次,其中79人次(99/10万)胸部影像学呈活动性肺结核病表现,其活动性肺结核病患病率低于我国15岁以上人群的459/10万;培养阳性率为29/10万,低于我国15岁以上人群的119/10万;涂片阳性率为26/10万,低于我国15岁以上人群的66/10万.分离培养出的23株MTB complex菌株中,9株至少对1种抗结核药物耐药,总耐药率为39.1%(9/23).单耐异烟肼1株(4.3%)、单耐链霉素2株(8.7%)、单耐吡嗪酰胺5株(21.7%).对3种药物(异烟肼、乙胺丁醇、吡嗪酰胺)合并耐药1株(4.3%).研究结果提示,上海口岸输入性肺结核病患病率水平低于我国和全球水平,但面临着输入性耐药肺结核病的风险.上海口岸输入性肺结核病的耐药特征为低利福平耐药率、高吡嗪酰胺耐药率,目前的DOTS方案仍有效.因此,有必要建立具口岸特色的耐药肺结核病防治措施,有效维护公共卫生安全.
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