2015年天津地区结核病患者耐药情况分析  

Analysis of drug resistance of tuberculosis in Tianjin

作　　者：王春花[1] 巨韩芳[1] 孙蕊[1] 王志锐[1] 赵慧[1] 傅衍勇 WANGChun-hua JUHan-fang SUNRui WANGZhi-rui ZHAO Hui FU Yan-yong(Tianjin Center for Tuberculosis Control, Tianjin 300041 , China)

机构地区：[1]天津市结核病控制中心,300041

出　　处：《结核病与肺部健康杂志》2016年第4期277-282,共6页Journal of Tuberculosis and Lung Health

摘　　要：目的 掌握天津地区2015年结核病患者耐药情况,为制定耐药结核病防治策略提供基础数据支持.方法 于2015年1月1日至2015年12月31日,收集天津地区全市共15家区（县）结核病防治机构或结核病定点医院及监狱医院均按要求登记上报的新结核病病例中痰菌培养阳性的菌株,共1325株.采用比例法药物敏感性试验分析不同来源患者菌株链霉素（Sm）、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、氧氟沙星（Ofx）和卡那霉素（Km）耐药率及耐药谱情况.结果 2015年天津地区总耐药率为26.1％（346/1325）,单耐药率13.5％（179/1325）,多耐药率6.0％（79/1325）,耐多药率6.6％（87/1325）,广泛耐药率0.4％（5/1325）.天津地区单耐链霉素[49.7％（89/179）]和单耐氧氟沙星[23.5％（42/179）]者最多.不同来源的患者中,来自监狱医院的肺结核患者多耐药率较高,为11.9％（5/42）;多耐药顺位中,Sm＋INH组合多耐药率最高,占45.6％（36/79）;不同年龄组患者的耐多药率差异有统计学意义（x2=13.58,P-0.004）,其中20～岁年龄组患者的耐多药率较高,为8.7％（41/469）.结论 天津地区耐药情况总体低于全国平均水平,耐药谱与全国情况不完全相同,其中对Ofx的耐药率较高,在耐多药二线药物治疗中应在药敏试验结果指导下慎重使用氟喹诺酮类药物.需要加强对监狱医院患者耐药结核病的防控.Objective To explore drug resistance of tuberculosis in Tianjin in 2015, based on which strategies for prevention and control of drug resistant tuberculosis could be developed. Methods A total of 1325 culture po- sitive strains from TB patients collected from 15 tuberculosis prevention and control sites in Tianjin. Ratio drug sen- sitivety test was used to analyze the drug resistant rate and resistance spectrum of different strains, six drugs were tested, including streptomycin （Sin）, isoniazid （INH）, rifampicin （RFP）, ethambutol （EMB）, ofloxacin （Ofx） and kanamycin （Kin）. Results In 2015, the overall resistance rate was 26.1% （346/1325）, single-drug-resistant （SDR） rate was 13.5 % （179/1325）, poly-drug-resistant （PDR） rate was 6.0% （79/1325）, multi-drug-resistant （MDR） rate was 6.6% （87/1325）, and extensively drug resistance （XDR） rate was 0. 4% （5/1325） % it was found that single-Sin-resistant （49.7%,89/179） and single-ofloxacin （Ofx）-resistant （23.5% ,42/179） constituted the lar- gest proportion. Patients from jail had the highest PDR rate （11.9 % （5/42））. Sm＋INH resistant was the highest in all PDR at the same time was the highest （45.6% （36/79））. As to ages, patients younger than 20 years old showed a higher MDR rate （x2=13.58, P：0. 004）. Conclusion The drug-resistant rate in Tianjin is lower than the average national rate, and the resistance spectrum is not completely the same as the national situation, the sin- gle-Ofx-resistant rate is higher than others. When patients are given the MDR treatment with second line tuberculo- sis drugs, the Fluoroquinolone drugs should be used based on the guidance of drug-susceptibility testing results. Prevention and control of drug-resistance tuberculosis in jail should be enhanced.

关 键 词：分枝杆菌 结核 结核 抗多种药物性 微生物敏感性试验 评价研究 

分 类 号：R52[医药卫生—内科学] R446.5[医药卫生—临床医学]