结核分枝杆菌对一线抗结核药物的耐药性分析  

Drug resistance of Mycobacterium tuberculosis strains to first-line anti-tuberculosis drugs

作　　者：李君[1] 单志力[1] 朱小梅[1] 毛玲琼[1] 张淑兰[1] 牛莹莹[2] LI Jun;SHAN Zhi-li;ZHU Xiao-mei;MAO Ling-qiong;ZHANG Shu-lan;NIU Ying-ying(Wenzhou Prefecture Center for Disease Control and Prevention,Wenzhou,Zhejiang 325001,China)

机构地区：[1]温州市疾病预防控制中心,浙江温州325001 [2]牡丹江医学院公共卫生学院,黑龙江牡丹江157011

出　　处：《中华医院感染学杂志》2018年第13期1925-1928,共4页Chinese Journal of Nosocomiology

基　　金：温州市科技局基金资助项目(Y20150292)

摘　　要：目的分析温州市肺结核患者对一线抗结核药物的耐药情况,为临床选择治疗方案和防控政策的制定提供依据。方法收集温州市2013年1月-2016年12月进行耐药检测的5324例肺结核患者信息及试验室检测数据,筛选出痰培养阳性且进行了一线抗结核药物敏感性试验的患者相关信息,对相关数据进行分析。结果 5324例患者中检出结核分枝杆菌3513例,检出率66.0%,初治2891例,复治622例;3513例结核分枝杆菌中耐药833例,总耐药率23.7%,其中初始耐药率为19.2%,获得性耐药率为44.7%;对4种一线抗结核药物耐药率由高到低依次是异烟肼、链霉素、利福平和乙胺丁醇;单一耐药330例,单耐药率9.4%,多耐药153例,多耐药率4.4%,耐多药350例,耐多药率10.0%,利福平耐药385例,利福平耐药率11.0%;4年间,温州市结核分枝杆菌总耐药率、耐多药率和利福平耐药率呈现逐年下降的趋势。结论温州市结核分枝杆菌的总耐药率低于国内平均水平,但耐多药率仍处于较高水平,应广泛开展分枝杆菌属培养和药敏试验,并根据药敏结果合理选择治疗方案。OBJECTIVE To investigate the drug resistance of pulmonary tuberculosis patients to first-line anti-tuberculosis drugs so as to put forward treatment regimens and prevention measures.METHODS The information and laboratory data were collected from 5324 pulmonary tuberculosis patients for whom the drug susceptibility testing was performed from Jan 2013 to Dec 2016,the patients who were positive for sputum culture were screened out,and the related data were analyzed.RESULTS Of the 5324 patients,3513 were tested positive for M.tuberculosis,with the isolation rate 66.0%;there were 2891 cases of initial treatment and 622 cases of retreatment.Totally 833 of 3513 strains of M.tuberculosis were drug-resistant,with the total drug resistance rate 23.7%;the initial drug resistance rate was 19.2%,and the acquired drug resistance rate was 44.7%.The drug resistance rates to the four types of first-line drugs,from high to low,were in turn as the followsing：isoniazid,streptomycin,rifampin,ethambutol.Totally 330 patients were one-drug resistant,with the one-drug resistance rate 9.4%;153 patients were multidrug-resistant,with the multidrug-resistance rate 10.0%;385 patients were resistant to rifampicin,with the drug resistance rate to rifampicin 11.0%.The total drug resistance rate,multidrug-resistance rate and resistance rate to rifampicin of the M.tuberculisis strains showed downward trends in Wenzhou during the four years.CONCLUSIONThe total drug resistance rate of the M.tuberculisis strains is lower in Wenzhou than the average level in China,however,the multidrug-resistance rate is relatively high.It is necessary to extensively carry out the culture of Mycobacteriumand the drug susceptibility testing so as to reasonably use antibiotics based on the result of the drug susceptibility testing.

关 键 词：结核分枝杆菌 一线抗结核药物 耐药 

分 类 号：R378.911[医药卫生—病原生物学]