2015-2019年西安市680例耐多药结核病患者耐药情况分析  

Analysis of drug susceptibility of 680 patients with multidrug-resistant tuberculosis in Xi’an City from 2015 to 2019

作　　者：马进宝 任斐 曾令城[3] 陈明伟[1] MA Jin-bao;REN Fei;ZENG Ling-cheng;CHEN Ming-wei(The First Affiliated Hospital of Xi’an Jiaotong University;Department of Drug-resistance tuberculosis,Xi’an Chest Hospital,Xi'an 710100,China;不详)

机构地区：[1]西安交通大学第一附属医院,710061 [2]西安市胸科医院,710061 [3]西安市疾病预防控制中心,710061

出　　处：《中国防痨杂志》2020年第6期609-613,共5页Chinese Journal of Antituberculosis

摘　　要：目的分析西安市耐多药结核病患者的药物敏感性试验结果,为指导西安市耐多药结核病患者的临床用药提供参考。方法收集西安市2015—2019年诊断为耐多药结核病的680例患者为研究对象,收集其对乙胺丁醇(EMB)、链霉素(Sm)、丙硫异烟胺(Pto)、阿米卡星(Am)、卷曲霉素(Cm)、对氨基水杨酸钠(PAS)、左氧氟沙星(Lfx)、莫西沙星(Mfx)行药物敏感性试验的结果,分析5年中耐多药结核病患者对8种药品的耐药率及其变化情况。结果(1)2015—2019年680例耐多药结核病患者对8种药品的耐药率从高到低分别为:Sm[85.7%(583/680)]、Lfx[40.1%(273/680)]、EMB[37.5%(255/680)]、Mfx[31.3%(213/680)]、PAS[14.4%(98/680)]、Pto[4.6%(31/680)]、Am[4.4%(30/680)]、Cm[4.3%(29/680)]。(2)2015—2019年对二线抗结核药品的耐药率均有所下降,分别为:Am(6.9%下降至3.0%,χ趋势2=2.78,P=0.096)、Cm(10.3%下降至3.0%,χ趋势2=6.96,P=0.008)、Lfx(55.2%下降至28.4%,χ趋势2=24.97,P=0.000)、Mf x(43.1%下降至22.9%,χ趋势2=16.45,P=0.000)、Pto(6.9%下降至6.0%,χ趋势2=0.44,P=0.506)、PAS(20.7%下降至8.0%,χ趋势2=7.79,P=0.005)。(3)对二线抗结核药品交叉耐药情况:对Am耐药的30例中有21(70.0%)例对Cm耐药,对Cm耐药的29例中有21例(72.4%)对Am耐药,对Lfx耐药的273例中有205例(75.1%)对Mfx耐药,对Mfx耐药213例中有205例(96.2%)对Lfx耐药。结论2015—2019年西安市耐多药结核病患者对EMB、Sm的耐药率一直较高,对二线抗结核药品的耐药率均有所下降,但对喹诺酮类药品的高耐药率仍需关注,在选择药品时应注意对各药品耐药率的不同及二线药品高交叉耐药情况。Objective A retrospective analysis of drug susceplibility test(DST)results of mult id rugresistant tuberculosis(MDR-TB)patients was carried out to provide evidence for guiding clinical drug administration for MDR-TB patients.Methods All of 680 MDR-TB patients in Xi’an City from 2015 to 2019 were selected as study subjects.The DST results of ethambutol(EMB),streptomycin(Sm),protionamide(Pto),amikacin(Am),capreomycin(Cm),P-aminosalicylic acid(PAS),levofloxacin(Lfx)and moxifloxacin(Mfx)were collected and analyzed.Results(1)The rates of resistance to different drugs could be listed from high to low as:Sm(85.7%(583/680)),Lfx(40.1%(273/680)),EMB(37.5%(255/680)),Mfx(31.3%(213/680)),PAS(14.4%(98/680)),Pto(4.6%(31/680)),Am(4.4%(30/680)),and Cm(4.3%(29/680));(2)The rates of resistance to several second-line anti-tuberculosis drugs decreased from 2015 to 2019:Am(from 6.9%decreased to 3.0%,χtrends2=2.78,P=0.096),Cm(10.3%/3.0%,χtrends2=6.96,P=0.008),Lfx(55.2%/28.4%,χtrends2=24.97,P=0.000),Mfx(43.1%/22.9%,χtrends2=16.45,P=0.000),Pto(6.9%/6.0%,χtrends2=0.44,P=0.506),Pas(20.7%/8.0%,χtrends2=7.79,P=0.005).(3)Cross resistance of second-line anti-tuberculosis drugs:among30 cases resistant to Am,21(70.0%)cases were resistant to Cm;in 29 cases resistant to Cm,21(72.4%)cases were resistant to Am;205(75.1%)cases were resistant to Mfx in 273 Lfx-resistant cases,205(96.2%)cases were resistant to Lfx in 213 Mfx-resistant cases.Conclusion In these 5 years,MDR-TB patients in Xi’an City kept a high resistance rate to EMB and Sm.The drug resistance rates of second-line anti-tuberculosis drugs decreased,but we still need to pay attention to the high resistance rate of quinolone.Those resistance rates to different drug and high cross-resistance rate among second-line anti-tuberculosis drugs should be considered when selecting drugs.

关 键 词：结核 抗多种药物性 微生物敏感性试验 数据说明 统计 西安市 

分 类 号：R52[医药卫生—内科学]