首次复治及二次复治菌阳肺结核耐药情况分析  

Analysis of drug resistances in the first and second times retreatment pulmonary tuberculosis with smear-positive

作　　者：戈启萍[1,2] 黄学锐[1,2] 杜建[3] 韩喜琴[1,2] 谢莉[1,2] 姜广路[4] 高微微[5] 

机构地区：[1]首都医科大学附属北京胸科医院 [2]北京市结核病胸部肿瘤研究所结核一科,101149 [3]首都医科大学附属北京胸科医院临床中心办公室,101149 [4]首都医科大学附属北京胸科医院参比实验室,101149 [5]首都医科大学附属北京胸科医院门诊部,101149

出　　处：《北京医学》2013年第12期989-992,共4页Beijing Medical Journal

基　　金："十一五"国家科技重大专项(2008ZX10003-015)

摘　　要：目的评价首次复治及二次复治菌阳肺结核的耐药情况。方法采用前瞻性多中心研究,对首次及2次复治菌阳肺结核患者行痰罗氏结核分枝杆菌培养、药敏试验,对两组耐药类型、一线及二线抗结核药物耐药情况进行分析。结果二次复治患者抗结核药物总耐药率(67.9%)明显高于首次复治患者(40.5%),差异有统计学意义(P<0.05);二次复治患者单耐药率、耐多药率、耐左氧氟沙星(Lfx)率分别为25.6%、26.9%、14.3%,明显高于首次复治患者的耐药率(15.1%、16.6%、7.1%),差异有统计学意义(P均<0.05)。二次复治患者对异烟肼及利福平的耐药率分别为46.2%、39.7%,均显著高于首次复治病例(28.8%、19.2%),P均<0.05。结论二次复治肺结核患者耐药率较首次复治病例明显增加,耐多药肺结核发生率及对利福平、异烟肼的耐药率均明显提高,因此应重视首次复治肺结核患者的规范化治疗,减少复治次数,对复治患者应及时进行药敏试验,以指导临床用药。Objective To analyze the drug resistance in the first and second-time retreatment pulmonary tubercu- losis（PTB）. Methods A prospective multi-center study was performed in the first and second-time retreatment PTB pa- tients. Sputum culture, species identification and drug sensitivity test were performed simultaneously. The differences of drug resistance types and situations were analyzed. Results The total drug resistance rate of the second-time retreatment was significantly higher than that of the first-time retreatment （67.9% vs. 40.5%, P 〈 0.05）. The single resistance rate （25.6%）, multi-drug resistance rate （26.9%） and resistance rate to levofloxacin （Lfx） （14.3%）in the second-time retreatment were significantly higher than those of the first-time retreatment （15.1%, 16.6%, 7.1%）, P 〈 0.05. Isoniazid （H） and ri- fampiein （R） resistance rate （46.2%, 39.7%） in the second-time retreatment were significantly higher than those of the first-time retreatment （28.8%, 19.2%）, P 〈 0.05. Conclusion The drug resistance rate is higher in the second-time re- treatment than that of the first time retreatment. The incidence of multi-drug resistance TB and H, R resistant ratio signifi- cantly increase. More attention should be paid for the standard treatment and management on the first-time retreatment pa- tients, in order to reduce the retreatment times, drug resistance test should be made for those patients under more than one time retreatment of PTB.

关 键 词：肺结核 复治 耐多药 

分 类 号：R521[医药卫生—内科学]