广西壮族自治区涂阳肺结核患者的耐药性分析  

Anti-tuberculosis drug resistance analysis of patients with smear positive pulmonary tuberculosis in Guangxi

作　　者：蓝如束[1] 蓝兰[1] 黄曙海[1] 刘飞鹰[1] 区进[1] 张影坤[1] 赵锦明[1] 

机构地区：[1]广西壮族自治区疾病预防控制中心结核病防制所,南宁530028

出　　处：《中国防痨杂志》2013年第9期673-678,共6页Chinese Journal of Antituberculosis

基　　金：广西壮族自治区科技攻关项目(桂科攻1140003A-36)

摘　　要：目的通过对广西壮族自治区(简称"广西")涂阳肺结核患者耐药性的监测,了解该地区肺结核患者耐药谱构成,阐明其对不同药物的耐药分布和规律。方法对广西30家结核病防治机构门诊收集的1765例涂阳肺结核患者的痰标本进行痰培养,对鉴定为结核分枝杆菌复合群的1545株菌株进行药敏试验,根据药敏结果分析患者耐药谱组成特点及其意义。结果初治涂阳患者组对一线药物任一耐药率高低顺位依次为异烟肼7.93%(94/1186)、链霉素6.24%(74/1186)、利福平3.20%(38/1186)和乙胺丁醇1.85%(22/1186);复治患者组对一线药物任一耐药率依次为异烟肼25.91%(93/359)、利福平25.07%(90/359)、乙胺丁醇13.65%(49/359)和链霉素11.98%(43/359),两组比较差异有统计学意义(χ2=43.174,P<0.01)。共发现25种耐药谱组合,耐多药患者耐一线药组合中,初治组以HRS(8例)、HRE(5例)和HR(5例)组合为主;复治组以HRE(17例)和HR(15例)组合为主。除耐一线药物外,初、复治患者都有耐二线药物的患者,其中初治患者耐卡那霉素1例、耐氧氟沙星12例;复治患者耐卡那霉素6例、耐氧氟沙星31例。结论广西初治、复治患者任一耐一线药率高低排序不同;广西结核病患者耐药谱组合形式多样,初治患者以HRS、HRE和HR组合为主,复治患者以HRE和HR组合为主。Objective To investigate the drug resistant spectrum of patients with smear positive pulmonary tuberculosis （PTB） in Guangxi, and to clarify the distribution and law of drug resistance. Methods A prospective survey was conducted to recruit smear-positive PTB patients in the clinics of 30 TB control institutes in Guangxi. Sputum samples from 1765 cases were cultured and 1545 isolates of Mycobacterium tuberculosis were identified. Anti- TB drug susceptibility tests were conducted for 1545 isolates of Mycobacterium tuberculosis by conventional proportion method for isoniazide （H）, rifampicin （R）, ethambutol （E）, streptomycin （S）, ofloxacin （Ofx） and kanamycin （Kin）. Data for prior administration of anti-TB drugs were collected. Results The drug resistance rates of new ca- ses to first line drugs was found in isoniazide 7.93% （94/1186）, followed by streptomycin 6.24% （74/1186）, rif- ampicin 3.20% （38/1186） and ethambutol 1.85G （22/1186）, and those were 25.91% （93/359） for isoniazide, followed by rifampicin 25.07% （90/359）, ethambutol 13. 65% （49/359） and streptomycin 11.98% （43/359） in previously treated cases. The difference of proportion of any first line drug resistance between new cases and pre- viously treated cases was statistically significant （X^2= 43. 174, P〈0.01）. There were 25 types of combinations of drug resistance among drug resistant cases. In the combinations to first line drugs, HRS （8 cases）, HRE （5 cases） and HR （cases） were most common in new cases, and HRE （17 cases） and HR （15 cases） were most common in previously treated cases. Besides first line drug resistance, second line drug resistance was found in both new and previously treated patients. One cases was resistant to Kin and 12 cases were resistant to Ofx in new cases. While in previously treated cases, the numbers were 6 and 31. Conclusion Results suggest that the orders of drug resis- tance rate of new and previously treated cases to first line drugs are

关 键 词：结核 肺 抗药性 细菌 广西[壮族自治区] 

分 类 号：R521[医药卫生—内科学]