不同时期住院复治培阳肺结核病人结核菌耐药情况分析  

Analysis of drug resistance of retreatment TB inpatient sputum culture positive at different period

作　　者：王星 陈建中 张丽红 李海 王俊明[3] 陈向东 庞春萍 贾爱福 石生君 

机构地区：[1]张家口市肺科医院,河北075441 [2]张家口市第六医院 [3]河北北方学院预防医学教研室

出　　处：《医学动物防制》2018年第3期210-213,共4页Journal of Medical Pest Control

基　　金：河北省科技计划项目(142777100D)

摘　　要：目的了解张家口地区复治培阳肺结核病人不同时期耐药变化情况,为制定和完善结核病控制措施、改进结核病防控工作提供依据。方法收集1993-1995年(下称A期)和2013-2015年(下称B期)前后两个时期在某院住院的痰结核分枝杆菌培养(+),并有药物敏感试验结果的复治肺结核病人170例,其中A期50例、B期120例,就其有关项目进行调查分析。结果前后两个时期总耐药率分别为94.0%(47/50)和86.7%(104/120),耐两种以上药物的耐药率分别为74.0%(37/50)和67.5%(81/120),其中耐多药率分别为66.0%(33/50)和30.8%(37/120);耐药顺位由高至低A期为INH 82.0%(41/50)、RFP 66.0%(33/50)、Sm 62.0%(31/50)、EMB 32.0%(16/50)、Am 14.0%(7/50)、PAS 10.0%(5/50)、Cm 8.0%(4/50),B期为INH 53.3%(64/120)、RFP 50.0%(60/120)、Lfx 34.2%(41/120)、EMB 27.5%(33/120)、PZA 25.8%(31/120)、PAS 23.3%(28/120)、Pto 13.3%(16/120)、Am和Cm均为5.8%(7/120)。AB前后两个时期相比,总耐药率、耐各药的任何耐药率以及耐两种以上药物的耐药率均有下降,但只有INH的耐药率和耐两种以上药物中含HR的耐药率下降明显(χ~2=12.282、18.020,P<0.05)。结论张家口地区复治肺结核病人结核菌耐药率AB两个时期相比,多项指标下降不明显,且高于近年来国内文献报告。应予高度重视,采取有效措施降低复治耐药率。Objective To investigate the chance of drug resistance in retreatment sputum culture positive TB inpatients in this region,and to provide evidence for the establishment and improvement of TB control measures and TB preventions. Methods To collect 170 cases of retreatment pulmonary TB inpatients are indived A group（50 cases 1993-1995） and B group（120 cases2013-2015）. All cases are positive of sputum culture and had the results of drug sensitivity test in our hospital at different two time,those cases are investigated and analysed on the relevant item. Results The total drug resistance rates of A and B in two period went respectively 94. 0%（47/50） and 86. 7%（104/120）. The resistance rates two or more drugs were respectively74. 0%（37/50） and 67. 5%（81/120）. The MDR rates went respectly 66. 0%（33/50） and 30. 8%（37/120）. The A resistance rank ranged from high to low is INH 82. 9%（41/50）,RFP 66. 0%（33/50）,SM 62. 2%（31/50）,EMB 32. 0%（16/50）,Am 14. 0%（7/50）,PAS 10. 0%（5/50）,Cm 8. 0%（4/50）. The B resistance rank ranged from high to low is INH 53. 3%（64/120）,RFP 50. 0%（60/120）,Lfx 34. 2%（41/120）,EMB 27. 5%（64/120）,PZA 25. 8%（31/120）,PAS 23. 3%（28/120）,Pto 13. 3%（16/120）,Am 5. 8%（7/120）,Cm 5. 8%（7/120） compared with the two periods of A and B： the total drug resistance rate,the resistance rate of each drug,and the resistance of two or more drug declined. however,only the resistance rate of INH and the resistance rate of HR containing more two kinds of drugs decreased significantly（χ~2= 12. 282,18. 020,P〈 0. 05）. Conclusion Local pulmonary TB drug resistance rate compare A and B period show that a number of indicators of decline is not obvious,and higher than these reported in domestic literature in recent years,more attention should be paid to take effective measures to reduce the resistant rate.

关 键 词：结核 肺 痰 抗药性 细菌 

分 类 号：R521[医药卫生—内科学]