浙江省耐多药肺结核患者对二线药物的耐药情况及近期疗效分析  

Drug resistance and short-term efficacy of second-line drugs in patients with multidrug-resistant pulmonary tuberculosis in Zhejiang Province

作　　者：范玉美[1] 李凫坚[1] 夏强[1] 张艳[1] 金丽娟[1] 

机构地区：[1]杭州市红十字会医院结核科,310003

出　　处：《中华临床感染病杂志》2015年第1期26-30,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：杭州市卫生局重大科技项目（20122009）

摘　　要：目的 观察对一线抗结核药物不同耐药类型的耐多药肺结核（MDR-PTB）患者对二线药物的耐药情况及近期疗效.方法 选择2011年3月至2013年3月浙江省结核病诊疗中心使用标准方案治疗的MDR-PTB患者183例,根据一线药物的药敏试验结果分为耐异烟肼（H）＋利福平（R）组（A组,30例）、耐HR＋乙胺丁醇（E）组（B组,28例）、耐HR＋链霉素（S）组（C组,53例）和耐HRES组（D组,72例）.分析四组患者对四种二线药物：卡那霉素（Km）、丙硫异烟胺（Pto）、对氨基水杨酸钠（PAS）和左氧氟沙星（Lfx）的耐药情况及治疗后痰培养结核分枝杆菌转阴率.多组间率的比较采用x2检验.结果 183例MDR-PTB患者对Lfx的耐药率（49例,26.8％）高于对Km（16例,8.7％）、Pto（24例,13.1％）和PAS（12例,6.6％）的耐药率（x2=37.983,P＜0.05）.D组患者对Lfx的耐药率（33/72,45.8％）高于A组（2/30,6.7％）、B组（6/28,21.4％）和C组（8/53,15.1％）（x2=14.413,5.047和13.087,P＜0.05）.D组早期广泛耐药（Pre-XDR）的发生率（25/72,34.7％）显著高于A组（3/30,10.0％）和C组（9/53,17.0％） （x2=6.499和4.852,P＜0.05）.157例MDR-PTB患者接受标准耐多药方案治疗满1年,痰培养转阴率为87.3％ （137/157）,其中D组患者的转阴率低于其他3组,但差异无统计学意义（x2=1.899,P＞0.05）.结论 MDR-PTB患者对一线抗结核药物的耐药类型是影响二线药物敏感性及其疗效的主要因素.在未获得二线药物药敏试验结果时,可参考一线药物的耐药类型,选择合理的耐多药化疗方案.Objective To investigate drug resistance and clinical efficacy of second-line anti-tuberculosis drugs in patients with multidrug-resistant pulmonary tuberculosis.Methods A total of 183 multi-drug resistant pulmonary tuberculosis （MDR-PTB） patients received standard anti-tuberculosis treatment in Zhejiang Provincial Center for Diagnosis and Treatment of Tuberculosis during March 2011 and March 2013.Patients were divided into four groups according to the results of first-line anti-tuberculosis drugs susceptibility test：group A （n =30） resistant to isoniazid （H） and rifamipicin （R） ; group B （n =28） resistant to HR and ethambutol （E） ; group C （n =53） resistant to HR and streptomycin （S） ; groups D （n =72） resistant to HRES.Drug susceptibility tests of second-line drugs kanamycin （Km）,protionamide （Pto）,paraaminosalicylic acid （PAS） and levofloxacin （Lfx） were performed.Negative conversion rates of mycobacterium tuberculosis in sputum culture were also observed and compared among different groups with x2 test.Results Among 183 MDR-PTB patients,49 cases （26.8%） were resistant to Lfx,which was significantly higher than that of Km （8.7%,n =16）,Pto （13.1%,n =24） and PAS （6.6%,n=12） （x2 =37.983,P〈0.05）.The resistant rate to Lfx in group D was 45.8% （33/72）,which was higher than that in group A （2/30,6.7%）,group B （6/28,21.4%） and group C （8/53,15.1%） （x2 =14.413,5.047 and 13.087,P 〈0.05）.The occurrence of pre-extensively drug resistance （Pre-XDR） in group D was 34.7% （25/72）,which was higher than that in group A （3/30,10.0%） and group C （9/53,17.0%） （x2 =6.499 and 4.852,P 〈 0.05）.Among 157 MDR-PTB patients who received standard anti-tuberculosis treatment for one year,the negative conversion rate of mycobacterium tuberculosis in sputum culture was 87.3% （137/157）.The negative conversion rate in group D was lower than that in other groups,but the difference was not of statistical significance （x2 =

关 键 词：结核 肺 广泛耐药结核 微生物敏感性试验 氧氟沙星 

分 类 号：R446.5[医药卫生—诊断学]