70例MDR-TB病例抗结核二线药物敏感性检测结果分析  

Analysis on results of susceptibility testing about four second-line anti-tuberculosis drugs in 70 MDR-TB patients

作　　者：黄明翔[1] 张丽水[1] 戴腊梅[1] 刘坦业[1] 

机构地区：[1]福建省福州肺科医院/福建医科大学临床教学医院,福州350008

出　　处：《中国人兽共患病学报》2012年第1期27-30,共4页Chinese Journal of Zoonoses

摘　　要：目的了解耐多药结核分枝杆菌临床分离株对二线药物耐药情况,评价BACTEC MGIT960系统在抗结核二线药敏试验中的临床应用价值。方法收集本院的痰培养阳性、经菌种鉴定和一线药物的药物敏感性试验确定为耐多药的结核分枝杆菌菌株。采用BACTEC MGIT960对4种二线药氧氟沙星(OFLX)、左氧氟沙星(LVFX)、阿米卡星(AMK)和卷曲霉素(CPM)进行药物敏感性检测,并与改良L-J罗氏培养法相比较。结果 (1)2008年10月至2009年4月,70例MDR-TB分离到的菌株,包括初治病例26例、复治病例44例,对4种药的总耐药率为61.4%(43/70)。对OFLX、LVFX、AMK和CPM耐药率分别为48.6%、40.0%、17.1%、7.1%。初治耐药率为57.7%(15/26),复治耐药率达63.6%(28/44)。符合XDR-TB诊断者5例(7.1%),包括初治者1例(1.4%),复治者4例(5.7%)。(2)BACTEC MGIT960二线药物敏感试验与改良L-J法相比,平均报告时间仅10.2d,明显短于L-J法,符合率在90%以上。结论 (1)在住院耐多药结核病患者中对这4种抗结核二线药物的耐药率已经到了一个较高水平;同时,当地存在XDR-TB,应该引起重视。(2)BACTEC MGIT960系统可以准确而快速地检测结核分枝杆菌对二线药物的耐受性。Our aim was to understand the resistance situation of second-line anti-TB（tuberculosis） drugs in the patients with multiple drug-resistance tuberculosis（MDR-TB）,and evaluate the clinical application for the drug susceptibility test of second-line anti-TB（tuberculosis） drugs by BACTEC MGIT960 system.The clinical Mycobacterium tuberculosis（M.tuberculosis） isolates from the patients with MDR-TB identified by PNB/TCH culture and the susceptibility testing on first-line drugs were collected in Fuzhou Pulmonary Hospital,Fujian Province.Drug susceptibility on 4 second-line drugs including ofloxacin（OFLX）,levofloxacin（LVFX）,amikacin（AMK） and capreomycin（CPM） were tested by means of the BACTEC MGIT960 system and compared improved L-J medium.Results showed that from October 2008 to April 2009,total of 70 MDR-TB patients,in which there were 26 initial cases and 44 retreated cases,were tested for drug resistance to the 4 second-line drugs.The total drug-resistance rate of the four drugs was 61.4%（43/70）.The drug-resistance rate to OFLX,LVFX,AMK and CPM was 48.6%,40.0%,17.1% and 7.1%,respectively.The drug-resistant rate of the first treated cases and the retreated cases was 57.7%（15/26） and 63.6%（28/44） respectively.There were 5 XDR-TB cases accounting for 7.1%,including 1 initial case（1.4%） and 4 retreated cases（5.7%）.The average report time of the drug susceptibility tests of second-line anti-TB drugs by BACTEC MGIT960 system was only 10.2 d,which was shorter than that of improved L-J medium.Identical proportion of drug susceptibility tests was higher than 90%.It＇s concluded that drug-resistance rate of the 4 drugs is in high level within MDR-TB patients who were treated in the hospital.It is needed to pay more attention to XDR-TB control and treatment because there is XDR-TB in Fujian Province.Meanwhile,BACTEC MGIT960 system is an accurate method for rapid testing of susceptibilities of M.tuberculosis to second-line drugs.

关 键 词：结核病 耐多药结核病 广泛耐药结核病 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]