231例脊柱结核患者耐药情况分析  

Analysis of drug resistance situation of Mycobacterium tuberculosis strains from 231 spinal tuberculosis patients

作　　者：王潮虹 孙晴 廖鑫磊 晏君 王晨倩 姜广路[1] 王芬 薛毅 黄海荣[1] 王桂荣[1] Wang Chaohong;Sun Qing;Liao Xinlei;Yan Jun;Wang Chenqian;Jiang Guanglu;Wang Fen;Xue Yi;Huang Hairong;Wang Guirong(Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Institute/National Clinical Laboratory On Tuberculosis/Beijng Key Laboratory for Drug Resistant Tuberculosis,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所/国家结核病临床实验室/北京市耐药结核病研究重点实验室,北京101149

出　　处：《中国防痨杂志》2022年第9期940-946,共7页Chinese Journal of Antituberculosis

基　　金：北京市通州区科技计划项目(KJ2022CX044);北京市高层次公共卫生技术人才建设项目(2022-3-040);北京市通州区高层次人才发展支持计划(YH201917)。

摘　　要：目的:分析231例脊柱结核患者的耐药特点,为临床医生制定脊柱结核治疗方案提供参考。方法:回顾性分析2016年1月至2021年12月首都医科大学附属北京胸科医院收治的231例脊柱结核住院患者信息,采用分枝杆菌微孔板药物敏感性检测技术测定来自231例脊柱结核患者的结核分枝杆菌对链霉素(Sm)、异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、利福喷丁(Rft)、左氧氟沙星(Lfx)、阿米卡星(Am)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸异烟肼(Pa)、莫西沙星(Mfx)、对氨基水杨酸(PAS)、克拉霉素(Clr)、利福布汀(Rfb)、卡那霉素(Km)和氯法齐明(Cfz)的敏感性。结果:脊柱结核患者对16种药物的总耐药率为34.63%(80/231),复治患者的总耐药率(75.44%,43/57)显著高于初治患者(21.26%,37/174),差异有统计学意义(χ^(2)=55.660,P<0.001)。脊柱结核患者任一耐药率顺位为:Sm(24.68%,57/231)>INH(22.51%,52/231)>Rft(19.05%,44/231)>RFP(18.18%,42/231)>Pa(15.58%,36/231)>Rfb(13.85%,32/231)>Lfx(7.79%,18/231)>PAS(7.36%,17/231)>Cm(5.63%,13/231)>Km(4.76%,11/231)=Cfz(4.76%,11/231)>Pto(4.33%,10/231)=Clr(4.33%,10/231)>EMB(3.90%,9/231)>Am(3.46%,8/231)>Mfx(2.60%,6/231)。脊柱结核患者多耐药率为11.69%(27/231),复治患者的多耐药率(19.30%,11/57)显著高于初治患者(9.20%,16/174),差异有统计学意义(χ^(2)=4.246,P=0.039);耐多药率为15.58%(36/231),复治患者的耐多药率(52.63%,30/57)显著高于初治患者(3.45%,6/174),差异有统计学意义(χ^(2)=46.980,P<0.001)。结论:脊柱结核存在严重的耐药问题,临床医生应根据患者药物敏感性试验结果制定有效的治疗方案。Objective:To analyze the drug resistance characteristics of 231 patients with spinal tuberculosis and to provide reference for clinicians to develop proper treatment regimens for spinal tuberculosis patients.Methods:The Mycobacterium tuberculosis strains and clinical data were collected from 231 culture-positive spinal tuberculosis patients,who were hospitalized in Beijing Chest Hospital from January 2016 to December 2021.Drug susceptibility test was performed for the following 16 drugs using ENCODE microplate methods:streptomycin(Sm),isoniazid(INH),rifampicin(RFP),ethambutol(EMB),rifapentine(Rft),levofloxacin(Lfx),amikacin(Am),capreomycin(Cm),prothionamide(Pto),isoniazid aminosalicylate(Pa),moxifloxacin(Mfx),p-aminosalicylic acid(PAS),clarithromycin(Clr),rifabutin(Rfb),kanamycin(Km)and clofazimine(Cfz).Results:The total drug resistance rate of those spinal tuberculosis patients to at least one of the 16 drugs was 34.63%(80/231),of which the drug resistance rate was significantly higher in previously treated patients(75.44%,43/57)than in new patients(21.26%,37/174),and the difference was statistically significant(χ^(2)=55.660,P<0.001).The drug resistance rates of spinal tuberculosis patients to the 16 drugs from high to low were:Sm(24.68%,57/231)>INH(22.51%,52/231)>Rft(19.05%,44/231)>RFP(18.18%,42/231)>Pa(15.58%,36/231)>Rfb(13.85%,32/231)>Lfx(7.79%,18/231)>PAS(7.36%,17/231)>Cm(5.63%,13/231)>Km(4.76%,11/231)=Cfz(4.76%,11/231)>Pto(4.33%,10/231)=Clr(4.33%,10/231)>EMB(3.90%,9/231)>Am(3.46%,8/231)>Mfx(2.60%,6/231).The poly-drug resistance rate of spinal tuberculosis patients was 11.69%(27/231),of which the poly-drug resistance rate was significantly higher in previously treated patients(19.30%,11/57)than in new patients(9.20%,16/174),and the difference was statistically significant(χ^(2)=4.246,P=0.039);The multidrug-resistance rate was 15.58%(36/231),of which the multidrug-resistance rate was significantly higher in previously treated patients(52.63%,30/57)than in new patients(3.45%,6/174),and the difference was sta

关 键 词：结核 脊柱 微生物敏感性试验 结核 抗多种药物性 数据说明 统计 

分 类 号：R529.2[医药卫生—内科学]