秦皇岛市结核病患者一线抗结核药物的耐药性调查  

Investigation on drug resistance of first-line anti-tuberculosis drugs for tuberculosis patients in Qinhuangdao City

作　　者：王宝英[1] 孙强[2] 张健[1] 李艳静[3] 刘鹏[1] 张继东[1] 闫佳会 WANG Bao-ying;SUN Qiang;ZHANG Jian;LI Yan-jing;LIU Peng;ZHANG Ji-dong;YAN Jia-hui(the Third Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第三医院检验科,河北秦皇岛066000 [2]秦皇岛市第一医院心内科,河北秦皇岛066000 [3]秦皇岛市第三医院肺二科,河北秦皇岛066000

出　　处：《临床肺科杂志》2019年第8期1454-1458,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的通过分析4年间结核病患者对4种一线抗结核药物的总体耐药情况,了解结核病的耐药特点及趋势,为结核病防治工作提供参考。方法收集2014年1月-2017年12月期间结核病患者送检的各类标本中分离出的结核分枝杆菌共849株,均采用比例法对链霉素(Streptomycin,S)、异烟肼(Isoniazid,H)、利福平(Rifampin,R)、乙胺丁醇(Ethambutol,E)4种一线抗结核药物进行药物敏感试验,SPSS统计软件进行数据分析,分析各年间的耐药变化趋势。结果自2014-2017年共分离出849株结核分枝杆菌,对一线抗结核药物的耐药率在2014年、2015年、2016年和2017年4年分别为50.2%(102/203),40.1%(59/147),37.2%(61/164)和29%(97/335);4年的总耐药率,总耐多药率、总单耐药率、总多耐药率分别为37.6%(319/849)、9.2%(78/849)、19.2%(163/849)和9.2%(78/849)。4年的利福平、异烟肼总耐药率分别为13.1%(111/849),17.3%(147/849);4种一线药物4年的总耐药率由高到低的排序分别为链霉素23.8%(202/849),异烟肼17.3%(147/849),乙胺丁醇14.5%(123/849),利福平13.1%(111/849)。2014~2017年度一线抗结核药物的单耐药、多耐药和利福平耐药呈逐年递降趋势,其中H多耐药的逐年增加趋势具有统计学意义(P<0.05)。链霉素和异烟肼的原发单耐药率高于继发单耐药率(P<0.05);原发R多耐药率高于继发R多耐药(P<0.05)。原发耐多药率(Multidrug-resistant tuberculosis,MDR-TB)低于继发MDR的耐药率(P<0.05)。结论H单耐药和H多耐药呈年度增加趋势,但仅H多耐药的差异具有统计学意义(P<0.05)应引起我们足够的重视,因为H也是抗结核的最关键药物之一。Objective To investigate the resistance to 4 kinds of first-line anti tuberculosis drugs in 4 years,and to observe the characteristics and trends of the drug resistance of tuberculosis so as to provide the reference for the prevention and control of tuberculosis.Methods A total of 849 Mycobacterium tuberculosis strains isolated from tuberculosis patients from January 2014 to December 2017 were collected,the drug susceptibility testing for four kinds of first-line anti-TB drugs,including streptomycin,isoniazid,rifampicin and ethambuto,was performed by using proportion method,and the data analysis with SPSS and the change rules and change tend of drug resistance in different years were observed.Results A total of 849 strains of Mycobacterium tuberculosis were isolated from 2014 to 2017,and the resistance rate to first-line anti-tuberculosis drugs was 50.2%(102/203),40.1%(59/147),37.2%(61/164),and 29%(97/335),respectively.In the past 4 years,the total drug resistance rate,total multi-drug resistance (MDR) rate,total single drug resistance (SDR) rate,and poly-resistant (PDR) rate was 37.6%(319/849), 9.2%(78/849),19.2%(163/849),and 9.2%(78/849),respectively.In the past 4 years,the total drug resistance rate of rifampicin and isoniazid was 13.1%(111/849) and 17.3%(147/849),respectively.In the four years,the highest resistance rate of the four first-line drugs were as follows:streptomycin 23.8%(202/849),isoniazid 17.3%(147/849),ethambutol 14.5%(123/849),and rifampicin 13.1%(111/849).The single-drug resistance,multi-drug resistance and rifampicin resistance of first-line anti-tuberculosis drugs from 2014 to 2017 showed a downward trend year by year.Among them,the increasing trend of H-resistance was statistically significant ( P< 0.05).The primary single drug resistance rate of streptomycin and isoniazid was higher than that of secondary single drug resistance ( P< 0.05).The primary R multi-drug resistance rate was higher than that of secondary R ( P< 0.05).The multi-drug resistant tuberculosis (MDR-TB) was lower than th

关 键 词：结核分枝杆菌 耐药率 抗结核药物 

分 类 号：R446.5[医药卫生—诊断学] R521[医药卫生—临床医学]