2014-2017年三亚市涂阳肺结核患者耐药监测结果分析  

Surveillance of smear-positive pulmonary tuberculosis patients in Sanya,2014-2017

作　　者：林永通[1] 黎永华[1] 黄隆[1] 李朝勇[1] LIN Yong -tong;LI Yong -hua;HUANG Long;LI Chao -yong(Sanya Center for Disease Control and Prevention,Sanya,Hainan 572000,China)

机构地区：[1]三亚市疾病预防控制中心结核病防治所,海南三亚572000

出　　处：《现代预防医学》2019年第3期522-526,共5页Modern Preventive Medicine

基　　金：海南省科技厅项目(KX2013003)

摘　　要：目的通过耐药监测了解三亚市涂阳肺结核患者的耐药状况,为三亚市结核病防治提供参考依据。方法收集三亚市2014年1月-2017年12月期间新登记活动肺结核患者中获得的602例涂阳肺结核患者的临床分离株,进行菌型鉴定,并采用WHO《结核病药物耐药性监测指南》推荐的比例法对分离菌株进行6种抗结核药物[利福平(RFP)、异烟肼(INH)、链霉素(Sm)、乙胺丁醇(EMB)、氧氟沙星(Ofx)、卡那霉素(Km)]的药物敏感性试验。对各种药物的初始耐药率、获得性耐药率、耐多药率、耐药顺位的差异进行分析。结果分离的602株菌株经菌型鉴定,共有结核分枝杆菌592株,总体耐药率为22. 97%(136/592),总耐多药率为5. 57%(33/592)。获得性耐药率41. 67%(40/96)高于初始耐药率19. 35%(96/496),差异有统计学意义(χ2=22. 27,P <0. 01)。6种药物耐药率顺位由高到低依次为Sm12. 67%(75/592)、INH 9. 46%(56/592)、RFP 8. 95%(53/592)、Ofx 5. 57%(33/592)、EMB 2. 20%(13/592)、Km2. 03%(12/592)。6种药物共出现22种不同耐药谱。不同性别、年龄组的耐药率差异无统计学意义。结论三亚市结核病患者总体耐药水平相对较低,仍需继续加强对本市结核病患者的耐药性监测。Objective To understand the drug resistance status of smear-positive tuberculosis patients in Sanya through drug resistance monitoring,and to provide a reference for tuberculosis prevention and control in Sanya City. Methods The clinical isolates of 602 patients with smear-positive pulmonary tuberculosis obtained from newly registered pulmonary tuberculosis patients were collected from January 2014 to December 2017 in Sanya City. The isolates were selected with the proportional method recommended by the WHO"drug-resistant TB drugs surveillance guidelines". 6 anti-tuberculosis drugs( rifampicin( RFP),isoniazid( INH),streptomycin( Sm),ethambutol( EMB),ofloxacin( Ofx),kanamycin( Km)) sensitivity tests were conducted. The initial resistance rate,acquired resistance rate,multidrug resistance rate,and drug resistance order of various drugs were analyzed. Results The isolates of 602 strains were identified by bacterial strains,and there were 592 Mycobacterium tuberculosis strains. The overall resistance rate was 22. 97%( 136/592),and the total multidrug resistance rate was 5. 57%( 33/592). The acquired drug resistance rate of 41. 67%( 40/96) was higher than the initial drug resistance rate of19. 35%( 96/496) with statistically significant difference( χ^2= 22. 27,P < 0. 01). The order of the six drug resistance rates from high to low was Sm 12. 67%( 75/592),INH 9. 46%( 56/592),RFP 8. 95%( 53/592),Off 5. 57%( 33/592),EMB 2. 20%( 13/592),Km 2. 03%( 12/592),respectively. A total of 22 different drug resistance profiles appeared for the six drugs. There was no significant difference in drug resistance rates between genders and age groups. Conclusion The overall level of drug resistance among tuberculosis patients in Sanya is relatively low. But it is still necessary to continue to strengthen the monitoring of drug resistance in tuberculosis patients in this city.

关 键 词：肺/结核 结核分枝杆菌 耐药性 监测 

分 类 号：R181.23[医药卫生—流行病学]