2009—2014年广东口岸肺结核患者耐药情况监测分析  

Analysis of drug susceptibility profiles of pulmonary tuberculosis cases at Guangdong port from 2009 to 2014

作　　者：高颖龙 温颖[1] 何洪涛[1] 王向阳[1] 吴健[1] 黄红敏[1] 史敏[1] 黄少英[1] 谭家辉 张建明[1] 

机构地区：[1]广东国际旅行卫生保健中心,广东广州510635

出　　处：《中国国境卫生检疫杂志》2016年第1期5-8,共4页Chinese Journal of Frontier Health and Quarantine

基　　金：广东检验检疫局科研基金项目(2013GDK51)

摘　　要：目的对广东口岸出入境人员肺结核患者耐药情况进行分析,为口岸结核病监测、防控和直接面视下服药的全程督导管理（Directly Observed Treatment,DOT）工作提供依据。方法采集广东口岸出入境人员疑似结核感染者连续3 d晨痰,采用液体、固体培养基联合进行细菌分离培养,用液体比例法（MGIT 960）对结核分枝杆菌培养阳性菌株进行一线药物敏感性检测,耐多药结核（MDR-TB）菌株进行二线药物敏感性检测。用Excel、SPSS 18.0统计软件,对涂阳患者、初治和复治患者、输入性结核患者的耐药情况和性别、年龄与结核耐药率的关系进行统计分析。结果 2009—2014年,广东口岸共发现8 755例肺结核疑似感染患者,其中489例结核分枝杆菌培养阳性菌株完成一线药物敏感性检测。一线药总耐药率为18.61%,耐药率顺位依次为异烟肼（H）12.68%、链霉素（S）9.82%、利福平（R）4.91%、吡嗪酰胺（Z）3.07%和乙胺丁醇（E）1.23%。耐多药结核分枝杆菌二线抗结核药物耐药率顺位分别为乙硫异烟胺（ETH）15.79%、对氨基水杨酸（PAS）10.53%、氧氟沙星（OFX）5.26%、阿米卡星（AK）5.26%、卷曲霉素（CM）5.26%。涂阳肺结核耐药率为19.57%,其中初治患者的涂阳肺结核耐药率为18.67%,复治患者的涂阳肺结核耐药率为23.53%。性别间耐药率（χ2=0.10,P〉0.05）和耐多药（MDR）率（χ2=0.91,P〉0.05）差异均无统计学意义。15-59岁青中年人群分别占初治单耐药结核（SDR-TB）和MDR-TB患者的80.85%和76.92%。复治患者耐R率10.61%、耐Z率9.09%和MDR率9.09%,分别高于初治患者的4.02%、2.13%和3.07%,差异均具有统计学意义（χ2=5.31,P〈0.05;χ2=9.31,P〈0.05;χ2=5.54,P〈0.05）。结论广东口岸存在一定耐药结核病传播风险,加强结核病患者的耐药性监测力度和高效的DOT,对预防耐药结核的跨国界传播十分必要。Objective To analyze the drug susceptibility characteristics of pulmonary tuberculosis（PTB） cases at Guangdong port,and to provide a scientific basis for Tuberculosis（TB） surveillance,prevention and control at ports.Methods Sputa for 3 consecutive days in the early morning of the international travel applicants who were suspected of TB patients were collected at Guangdong port from July,2009 to October,2014. Mycobacterium tuberculosis（MTB） were isolated and cultured by liquid and solid medium. MGIT 960 method was used to detect first-line and second-line anti-tuberculosis drug resistance which strains were multi-drug resistance tuberculosis（MDR-TB）. The drug-resistance proportion of smear positive PTB patients,initial treatment and retreatment PTB patients,imported PTB and the relationship between PTB drug resistance rate with sex and age groups were analyzed by Excel and SPSS18.0. Results A total of 8 755 suspected TB patients＇ sputa were detected. In which,489 strains were completed MTB drug sensitivity test. The total drug-resistance rate of first-line drugs was 18.61%. For first-line drugs,the drug-resistant proportion against isoniazid,streptomycin,rifampicin,pyrazinamide and ethambutol was 12.68%,9.82%,4.91%,3.07% and 1.23%,respectively. For sencond-line drugs,the drug-resistant proportion against ethionamide,4-Amino-2-hydroxybenzoicacid,ofloxacin,amikacin and capreomycin was 15.79%,10.53%,5.26%,5.26%,and 5.26% respectively. Smear positive PTB patients ＇ drug resistance rate was 19.57%. In which,initial treatment and retreatment PTB patients were 18.67% and 23.53%,respectively. There was no significant difference between genders with the detection rate of drug-resistance（χ2=0.10,P〈0.05） and MDR（χ2=0.91,P〈0.05）. 80.85%（38/47） of SDR PTB patients and 76.92% of MDR PTB patients were middle and young people（15 -59 years）.The drug-resistance rate of rifampicin,pyrazinamide and MDR rate of retreatment PTB patients was 10.61%,9.09% and9.09%,respectively,which were higher t

关 键 词：肺结核 耐药性 口岸 

分 类 号：R446.5[医药卫生—诊断学]