初始耐药肺结核患者临床特征及耐药情况分析  

Analysis of clinical features and drug resistance of patients with initial drug resistant

作　　者：李雪莲[1] 张立群[1] 刘荣梅[1] 陈红梅[1] 高孟秋[1] Li Xuelian;Zhang Liqun;Liu Rongmei;Chen Hongmei;Gao Mengqiu(Department of Tuberculosis Ward 2,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核二科,101149

出　　处：《北京医学》2018年第10期946-948,共3页Beijing Medical Journal

摘　　要：目的探讨初始耐药肺结核患者的临床特征并分析其耐药情况。方法回顾性分析就诊于首都医科大学附属北京胸科医院的初始耐药肺结核患者的临床表现、合并症、影像学表现等资料,探讨其临床特征并对耐药情况进行分析。结果 45例初始耐药肺结核患者中,男35例(77.8%),女10例(22.2%);年龄13~92岁,平均(39.8±19.5)岁。初始耐药肺结核患者耐药种类以耐多药结核病(multiple drug resistant tuberculosis, MDR-TB)为主(57.8%)。在检测的10种抗结核药物中,结核分枝杆菌复合群菌株耐药率顺位前5位依次为异烟肼(INH,66.7%)、利福平(RFP,62.2%)、链霉素(S,62.2%)、左氧氟沙星(LFX,22.2%)和氧氟沙星(OFX,15.6%)。女性患者的耐药率随年龄增长呈下降趋势,而男性患者分别在20~29岁及50~59岁各有一个高峰。青年组患者中MDR-TB的发病率最高(37.8%)。痰XpertMTB/RIF检测的耐药检出率为69.0%(29/42),与药物敏感试验的符合率为92.9%(39/42)。痰Hain检测的耐药检出率为62.2%(23/37),与药物敏感试验的符合率为75.7%(28/37)。结论初始耐药肺结核患者并不少见,对初始耐药患者的发现和诊断是MDR-TB疫情控制中重要的一个方面,基因检测方法可作为快速诊断方法。Objective To investigate the clinical features and analyze drug resistance of the initial drug-resistant tuberculosis（TB） patients. Methods The clinical manifestations, complications, BMI, misdiagnosis, and imaging findings of initially drug-resistant pulmonary tuberculosis（PTB） patients who visited the Beijing Chest Hospital were retrospectively analyzed. Clinical characteristics and drug resistance were analyzed. Results Of the 45 patients with initially drug-resistant PTB, 35（77.8%） were male and 10（22.2%） were female. They were 13～92（39.8 ± 19.5） years old. MDR-TB（57.8%） was the mainly drug resistance. Of the 10 anti-TB drugs tested, the top 5 were INH（66.7%）, RFP（62.2%）, S（62.2%）, LFX（22.2%） and OFX（15.6%）. The rate of drug resistance in female patients declined with age, while male patients had a peak in 20～29 and 50～59 years respectively. The incidence of MDR-TB was highest in young patients（37.8%）. The detection rate of resistance to XpertMTB/RIF was 69.0%（29/42）, and the coincidence rate with drug sensitivity test was 92.9%（39/42）. The rate of drug resistance detected by Hain test was 62.2%（23/37）, and the coincidence rate with drug sensitivity test was 75.7%（28/37）. Conclusion The initial drug-resistant TB patients are not uncommon.The discovery and diagnosis of these patients is an important aspect of the MDR-TB epidemic control and needs to be highly valued by the whole society. Gene detection methods can be used as a rapid diagnostic method.

关 键 词：初始耐药 结核 临床特征 

分 类 号：R521[医药卫生—内科学]