417例菌阳结核病患者药敏结果与临床特征相关性分析  

Drug susceptibility results and clinical characteristics as well as their correlation analysis from 417 cases with positive culture of tubercle bacilli

作　　者：尹洪云[1] 刘一典[1] 肖和平[1] 景玲杰[1] 乐军[1] 

机构地区：[1]同济大学附属上海市肺科医院,上海200433

出　　处：《中国实用内科杂志》2009年第12期1100-1102,共3页Chinese Journal of Practical Internal Medicine

基　　金：上海市公共卫生重点学科建设项目(08GWZX0104)

摘　　要：目的探讨结核病药敏结果与临床特征的相关性,为结核病患者治疗制定合理有效的方案提供理论依据。方法回顾性分析2008年1月至11月同济大学附属上海市肺科医院因结核病或肺部疾患住院者,送痰或病灶处标本行BACTEC960液体培养基中快速培养阳性者417例,所有菌株行链霉素(S)、异烟肼(H)、利福平(R)、乙胺丁醇(E)4种药物敏感试验,部分菌株加试阿米卡星(Am)、卷曲霉素(Cm)、氧氟沙星(Ofx)3种药物敏感试验。收集完成抗结核药物敏感试验患者的临床资料,分析菌株药物试验结果。剔除非结核分枝杆菌性肺部病变病例。结果(1)417例菌阳结核病患者,支气管结核68例(16.3%),糖尿病患者52例(12.5%)。(2)初治结核271例(64.99%),复治结核146例(43.01%)。总耐药率为53.5%,氧氟沙星总耐药率为36.86%。初始耐药率分别为S22.5%、H25.8%、R17.3%、E21.0%、Am6.3%、Cm10.0%、Ofx16.6%。获得性耐药率相应分别为67.8%、82.9%、68.5%、68.5%、19.9%、25.3%、58.2%。(3)耐多药结核143例,平均年龄(44.59±16.31)岁,明显低于非耐多药患者平均年龄(49.54±18.81)岁(t=0.008,P<0.01)。耐多药率34.3%(143/417),初始耐多药发生率为16.2%,获得性耐多药结核发生率67.81%。对耐多药形成起决定因素的是治疗性质,此外女性患者及是否合并支气管结核也有一定协同作用。从方案的执行情况分析可知,治疗失败与短期复发耐多药结核发生率分别为83.7%和85.2%,自行停药与不能耐受药物发生率分别为80.6%和27.3%。结论住院患者耐药及耐多药结核发生率较高,耐多药结核年龄呈低龄化倾向,女性及合并支气管结核者更易发展为耐多药结核,化疗方案的执行情况直接影响耐药结核的发生,而方案行使的结果可以作为判断是否发生耐多药结核的重要依据。Objective To understand the bacteriology and the association between drug susceptibility and clinical features from recent hospitalization of tuberculosis （TB） patients with positive tuberculosis bacilli culture. Methods We collected the clinical data of inpatients due to tuberculosis or pulmonary disease with positive tuberculosis bacilli by BACTEC960 culture auto-analysis system and possessing anti-tuberculosis drug susceptibility testing results from January 2008 to November 2008. All isolated strains were tested with first-line drugs included Streptomycin （S）, Isoniazid （H）, Rifampicin （R） and Ethambutol （E）. Some isolate strains were used to test Amikacin （Am） , Capreomycin （Cm） and Ofloxacin （Ofx）. We recorded the drug-tested results and clinical data and retrospectively analyzed them. The patients with pulmonary disease from nontuberculosis mycobacteria （NTM） were excluded. Results （ 1 ）There were 417 patients with positive culture of tuberculosis bacilli （ included 294 male and 123 female）. The mean age was（47.8 18. 1 ） years（ ranging from 6 to 91 years）. There were 68 cases complicated with endobronchial tuberculosis（EBTB） and 56 cases with type 2 diabetes mellitus. （2）There were 271 cases for initial treatment and 146 cases of relapsing tuberculosis. The total drug resistant rate was 53. 5 percent,and of oflx was as high as 31.86 percent. The initial drug resistant rate was S 22. 5%, H 25.8% , R 17.3% ,E 21.0% ,Am 6. 3% ,Cm 10. 0% ,Ofx 16.6% respectively and the required rate was 67. 8% ,82. 9% ,68. 5%,68.5%, 19. 9% ,25.3% ,58. 2% respectively. （ 3 ） There were 143 patients with multi-drug resistant TB （MDR-TB）. The mean age 44. 59 ± 16. 31 was significantly younger than of other patients（ P 〈 0. 01 ）. The incidence of MDR-TB was 34. 3 per-cent （initial rate 16. 2% and required rate 67.8% ）. The factors contributed MDR-TB came from treating failure （83.7%） , TB relapse in short period （85.2%） , self-stop treatment （

关 键 词：结核 耐药 支气管 糖尿病 

分 类 号：R5[医药卫生—内科学]