结核分枝杆菌对一线抗结核药物的耐药情况分析  

Analysis of resistance of mycobacterium tuberculosis to first-line anti-tuberculosis drugs

作　　者：闫莉 钟明浩 关福源 代艳杰 罗兰娇 YAN Li;ZHONG Ming-hao;GUANFu-yuan(The Sixth People’s Hospital,Dongguan,Guangdong Province,Dongguan511700,China)

机构地区：[1]东莞市第六人民医院,广东东莞511700

出　　处：《中国实验诊断学》2020年第3期381-384,共4页Chinese Journal of Laboratory Diagnosis

基　　金：国家疾病预防控制中心资助课题(2018ZX10103001)。

摘　　要：目的了解东莞市2015-2018年结核分支杆菌对四种一线抗结核药物的耐药情况以及耐药患者人群分布特征,为制定科学的耐药结核病治疗和预防策略提供依据。方法收集东莞市2015-2018年登记的痰培养阳性的肺结核患者3975例,菌群鉴定为结核分支杆菌的标本进行药敏试验。药敏试验采用比例法,药物敏感试验药物种类包含异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)四种一线抗结核药物。结果3751株结核分枝杆菌对一线抗结核药物总体耐药率为25.70%(964/3751),四年间总体耐药率呈逐年增高趋势。单耐药率、耐多药率和多耐药率分别为17.41%(653/3751)、3.81%(143/3751)、4.48%(168/3751)。单耐药中耐链霉素(Sm)比例最高,耐多药中INH+RFP+EMB+Sm四种全耐的菌株比例最高。3751株结核分支杆菌对四种一线抗结核药物的耐药顺位为:Sm14.98%(562/3751)>EMB10.16%(381/3751>INH9.68%(363/3751)>RFP5.01%(188/3751)。卡方检验结果显示,年龄越大越容易耐多药(χ^2=9.27,P<0.05)和多耐药(χ^2=6.18,P<0.05)。复治患者更易患单一耐药(χ^2=11.70,P<0.05)、耐多药(χ^2=200.81,P<0.05)和多耐药(χ^2=4.66,P<0.05)。结论东莞市各耐药率水平低于全国平均水平,但呈现逐年增高水平,防控形势不容乐观。建立持续的耐药监测机制以及提供更多的标准化治疗方案并将其纳入免费治疗序列势在必行。Objective To understand the drug resistance of mycobacterium tuberculosis to four first-line anti-tuberculosis drugs and the distribution characteristics of drug resistance patients in dongguan city from 2015 to 2018,To provide the basis for formulating scientific treatment and prevention strategies of drug-resistant TB.Methods 3975 cases of sputum culture-positive tuberculosis patients registered in dongguan city from 2015 to 2018 were collected.Mycobacterium tuberculosis specimens were identified as mycobacterium tuberculosis for drug susceptibility test.Drug sensitivity test was conducted by proportional method.Drug sensitivity test drugs include isoniazid(INH),rifampicin(RFP),streptomycin(SM),ethambutol(EMB),four first-line anti-tuberculosis drugs.Results Overall resistance rate of 3751 mycobacterium tuberculosis strains to first-line anti-tuberculosis drugs was 25.70%(964/3751).The overall drug resistance rate increased year by year during the four years.Single drug resistance rate,multi-drug resistance rate and multi-drug resistance rate were 17.41%(653/3751),3.81%(143/3751)and 4.48%(168/3751),respectively.Streptomycin(Sm)resistance was the highest in single drug resistance,while INH+RFP+EMB+Sm were the highest in multi-drug resistance.The sequence of resistance of 3751 mycobacterium tuberculosis strains to four first-line anti-binding drugs was:Sm14.98%(562/3751)>EMB10.16%(381/3751>INH9.68%(363/3751)>RFP5.01%(188/3751)).Chi-square test result shows that the older the easier multidrug-resistant(χ^2=9.27,P<0.05)and multiple drug resistance(χ^2=6.18,P<0.05).Retreatment patients more susceptible to a single drug resistant(χ^2=11.70,P<0.05),multidrug-resistant(χ^2=200.81,P<0.05)and multiple drug resistance(χ^2=4.66,P<0.05).Conclusion The drug resistance rate of Dongguan city is lower than the national average level,but the level is increasing year by year,the prevention and control situation is not optimistic.It is imperative to establish a continuous resistance monitoring mechanism and to provide more sta

关 键 词：分枝杆菌 结核 耐药 药物敏感实验 比例法 

分 类 号：R521[医药卫生—内科学]