282例肺结核患者结核分枝杆菌耐药基线调查及耐多药结核病影响因素分析  

Baseline study on drug resistance of tuberculosis of 282 patients and influencing factor of multi-drug resistance tuberculosis

作　　者：应潜 黄文辉[2] 陈小菁 蔡焕[1] 刘璀 易书林 张建冬 彭小梅[2] 杨丽琳 YING Qian;HUANG Wen-hui;CHENG Xiao-jing;CAI Huan;Liu Cui;Yi Shu-lin;Zhang Jian-dong;Peng Xiao-mei;Yang Li-lin(Yingtan Center for Disease Control and Prevention,Nanchang,Jiangxi 335001,China)

机构地区：[1]鹰潭市疾病预防控制中心,江西鹰谭335001 [2]江西省疾病预防控制中心,江西南昌330029 [3]鹰潭市人民医院,江西鹰谭335000

出　　处：《现代预防医学》2018年第19期3597-3600,3604,共5页Modern Preventive Medicine

摘　　要：目的初步掌握鹰潭市结核分枝杆菌耐药现状和流行特征,为制定有效化疗方案和防控措施提供科学依据。方法课题组对鹰潭市3个县(市)结防门诊2015年1月至2017年12月收治的1 384例患者,以酸性改良罗氏培养法进行痰培养,以含对硝基苯甲酸和噻吩二羧酸肼(PNB-TCH)培养基为鉴定培养基,进行分枝杆菌初步菌种鉴定,对最终纳入耐药检测的282株菌株,采用WHO推荐的比例法进行4种一线、2种二线抗结核药物敏感性试验,并对不同类型患者的耐药顺位情况和不同类型耐药谱进行统计分析。结果 282株菌株总耐率为20. 2%、耐多药率4. 6%;初、复治患者总耐药率、单耐药率、耐多药率分别为15. 0%、7. 5%、36. 2%和1. 9%、15. 9%、13. 0%,3组数据间差异均有统计学意义(χ~2=14. 536,P <0. 001;χ~2=4. 278,P=0. 039;χ~2=14. 775,P <0. 001); 6种抗结核药总耐药率顺位为INH> RFP>Ofx> EMB> Sm> Km;耐2种药耐药谱顺位居前3位者:INH+RFP(2. 8%)、INH+Ofx(2. 1%)、INH+Sm(1. 1%);耐3种药耐药谱顺位居前3位者:INH+RFP+Ofx(1. 1%)、RFP+EMB+Ofx(0. 7%)、INH+RFP+EMB(0. 4%);涂阳培阳的总耐药率、单耐药率、耐多药率分别为21. 4%、9. 3%、4. 9%,均高于涂阴培阳的15. 5%、6. 8%、3. 4%,但涂阴培阳的多耐药率5. 2%高于涂阳培阳的4. 9%。结论虽然鹰潭市结核病总体耐药率和耐多药率均低于全国平均水平,但耐药疫情仍然不容乐观,要进一步提高现代结核病控制策略质量,积极采取干预措施,规范临床治疗,开展耐药检测新技术,有效遏制耐药结核病疫情。Objective To master the current status and epidemic characteristics of mycobacterium tuberculosis resistance in yingtan city preliminarily, and to provide the scientific basis for the establishment of effective chemotherapy and prevention and control measures. Methods Yingtan city group of 3 counties （cities） and the outpatient service between January 2015 and December 2015, 1384 patients were treated, sputum culture in acidic roche culture method, and p- nitrobenzoic acid containing thiophene dicarboxylic acid hydrazine （ PNB - TCH） medium for identification of culture medium, the strains of mycobacteria preliminary identification, the final resistance test of 282 strains, the WHO recommended ratio method is used to four line, two kinds of second - line anti - tb drugs sensitivity test, and the sequence of the resistance of different kinds of patients condition and different types of drug - resistant spectrum were analyzed. Results The total drug resistance of 282 strains was 20.2% and Multi - drug resistant rate was 4.6%. The total drug resistance rate, single drug resistance rate and multi - drug resistance rate were 15.0% , 7.5%, 36.2% and 1.9%, 15.9% and 13.0% respectively in the first and second treatment patients, and the differences among the three groups were statistically significant （ X^2 = 14. 536, P 〈0. 001 ; X^2 = 4. 278, P = 0.039 ;X^2 = 14. 775, P 〈 0. 001 ）. The total drug resistance rate of the six antituberculosis drugs was INH 〉 RFP 〉 Ofx 〉 EMB 〉 Sm 〉 Kin; The two drug resistance spectrums were in the top three： INH ＋ RFP（2.8% ）, INH ＋ Ofx（2.1% ）, INH ＋ Sm（ 1.1% ） ; The three - drug resistance spectrums were in the top three： INH ＋ RFP ＋ Ofx （ 1.1% ）, RFP ＋ EMB ＋ Ofx （0.7%）, INH ＋ RFP ＋ EMB （0.4%）. The total drug resistance rate, single drug resistance rate and multi -drug resistance rate of patients with smear - positive and culture - positive were 21.4%, 9.3% , 4.9% which was higher than 15. 5%, 15.5%, 3.4% of patients w

关 键 词：结核 肺 结核分枝杆菌 耐药性 多种 流行 

分 类 号：R183[医药卫生—流行病学]