惠州市结核分枝杆菌的耐药状况及原因分析  

Prevalence and risk factors of drug resistant Mycobacterium tuberculosis in Huizhou City

作　　者：韩珍[1] 李晓芬[1] 冷雪 

机构地区：[1]惠州市结核病防治研究所,广东惠州516008 [2]惠州市中信惠州医院,广东惠州516006

出　　处：《现代预防医学》2015年第10期1850-1852,共3页Modern Preventive Medicine

基　　金：惠州市科学技术项目(2013Y104)

摘　　要：目的探讨惠州市人群结核分枝杆菌耐药状况及其影响因素,为临床合理用药及结核病有效控制提供参考。方法选取2013年5月-2014年4月期间某院门诊病人及惠城区、惠东县、惠阳县、博罗县、龙门县及惠州市大亚湾地区送检的痰标本进行培养,经培养阳性的结核分枝杆菌,采用1%比例法进行一线抗结核用药(INH、RFP、EMB、SM)药敏试验,统计药敏结果并分析原因。结果共收集1 248株阳性分枝杆菌,其中1 179株(94.47%)为结核分枝杆菌。1 179株结核分枝杆菌中,799株(67.77%)对4种抗结核病药均有敏感性,即总体耐药率为32.23%,单耐药率为11.96%,多耐药率为7.89%,耐多药率为12.38%;获得性耐药率明显高于初始耐药率;结核分支杆菌对4种抗结核药物的耐药率为INH(12.27%)>RFP(8.04%)>SM(7.31%)>EMB(4.86%)。多因素Logistic回归分析显示,耐药的发生与户籍类型、抗结核治疗史有关(P均<0.05);耐多药的发生与年龄、性别、户籍类型、抗结核治疗史有关(P均<0.05)。结论惠州市人群结核分枝杆菌耐药率高,耐多药率高和获得性耐药率高,有必要加强抗结核药物耐药性的监测,指导临床合理用药,采取切实措施控制耐药结核的蔓延。Objective This work was to investigate the prevalence and risk factors of drug resistant Mycobacterium tuberculosis（MTB） by a population-based study in Huizhou City, so as to provide a reference for drug resistant tuberculosis prevention and control. Methods From 2013 May to 2014 April, all sputum smear positive isolates from pulmonary tuberculosis patients in Huizhou City were collected and then tested for the first-line anti-TB drug（INH, RFP, EMB, SM） susceptibility with 1% proportion method. The result was statistically analyzed and the risk factors were also studied. Results A total of 1248 isolates were collected,of which 1179 were Mycobacterium tuberculosis（MTB）. The drug susceptibility test showed that 799（67.77%） MTB strains were sensitive to all the four antibiotics and the other 380（32.23%） strains were resistant to at least one drug. 11.96% of the isolates were single-drug resistant, and 7.89% were multidrug resistant. The acquired resistance rate was 63.81%, which was significantly higher than the initial resistance rate. The drug resistance of MTB to the four antibiotics were INH（12.27%） RFP（8.04%） SM（7.31%） EMB（4.86%）. Multiple logistic regression analysis showed that drug resistance was correlated with treatment history and residence type（P〈0.05）, and multi-drug resistance was related to age, gender, treatment history and residence type（P〈0.05）.Conclusion The high prevalence MTB drug resistance forms a severe challenge for TB control in Huizhou City. It is necessary to take effective measures to strengthen the anti-TB drug resistance surveillance and to control the spread of drug-resistant TB.

关 键 词：惠州市 结核分枝杆菌 耐药及耐多药 原因分析 

分 类 号：R183.3[医药卫生—流行病学]