海南省697例耐药结核分枝杆菌药敏试验结果分析  

Analysis of drug susceptibility test results of 697 cases of drug-resistant Mycobacterium tuberculosis in Hainan Province

作　　者：张福威 刘瑞 陈善颖 何晶[1] ZHANG Fuwei;LIU Rui;CHEN Shanying;HE Jing(Department of Infectious Diseases and Tropical Diseases,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570100,China)

机构地区：[1]海南医学院第二附属医院感染病与热带病科,海南海口570100

出　　处：《中国热带医学》2023年第8期839-845,共7页China Tropical Medicine

基　　金：海南省科技厅省重大科技计划项目(No.ZDKJ201804);海南省临床医学中心建设项目(No.琼卫医函[2021]276)。

摘　　要：目的了解海南省结核病医院2019—2021年结核分枝杆菌(Mycobacterium tuberculosis,MTB)的耐药类型及分布情况,为制定耐药结核病防控策略提供参考依据。方法收集2019—2021年收治的经痰分离培养并鉴定为MTB的共1687例菌株,进行8种抗结核药物[异烟肼(isoniazid,INH)、利福平(rifampin,RFP)、乙胺丁醇(ethambutol,EMB)、链霉素(streptomycin,SM)、卡那霉素(kanamycin,KM)、卷曲霉素(coleomycin,CPM)、氧氟沙星(ofloxacin,OFX)、丙硫异烟胺(propylthioisonicotinamide,PTO)]的药物敏感性试验,分析耐药情况。结果MTB菌株1687例,总耐药率为41.32%(697株),单耐药率为11.62%(196株),多耐药率4.10%(69株),耐多药率为23.71%(400株),广泛耐药率为1.90%(32株),利福平耐药率为28.10%(474株),耐药类型以耐多药和利福平耐药为主。8种耐药顺位OFX(64株)>SM(62株)>INH(48株)>RFP(19株)>CPM(2株)>KM(1株)>EMB(0株)及PTO(0株)。初治患者对一线药物INH、RFP的耐药率低于复治患者(χ^(2)=0.110,0.765;P>0.05);初治患者对二线药物OFX、CPM、KM的耐药率低于复治患者(χ^(2)=1.037,1.212,1.653;P>0.05)。2019年的总耐药率51.16%高于2020的35.08%和2021年的38.89%,组间比较差异有统计学意义(χ^(2)=29.25,16.60;P<0.001);2020年和2021年组间总耐药率差异无统计学意义(χ^(2)=1.823,P=0.177)。在肺结核患者的职业类型中,以农民为主,占比56.25%(949株)。耐药肺结核患者主要分布在海口市(165株)>万宁市(72株)>澄迈县(64株)>文昌市(51株)=东方市(51株)>儋州市(48株),这6个地区共占比64.71%(451/697)。结论海南省肺结核耐药率较高,以OFX、SM耐药为主。耐多药率高于全国平均水平,应加强监测,优化治疗方案,以减少耐药结核病流行。Objective To investigate the type and distribution of drug resistance of Mycobacterium tuberculosis(MTB)in Hainan tuberculosis hospital from 2019 to 2021,and to provide reference for the development of drug resistant tuberculosis prevention and control strategy.Methods From 2019 to 2021,a total of 1687 strains of sputum were isolated and cultured and identified as MTB.Drug sensitivity testing was performed on eight anti-tuberculosis drugs:isoniazid(INH),rifampicin(RFP,R),ethambutol(EMB),streptomycin(SM),kanamycin(KM),capreomycin(CPM),ofloxacin(OFX),and propylthioisoniacamide(PTO).The drug resistance analysis was conducted.Results Among the 1687 MTB strains,the overall drug resistance rate was 41.32%(697),with a single drug resistance rate of 11.62%(196),a multi-drug resistance rate of 4.10%(69),a extensive drug resistance rate of 23.71%(400),a pan-drug resistance rate of 1.90%(32),and a rifampicin resistance rate of 28.10%(474),and the main drug resistance types were extensive drug resistance and rifampicin resistance.The order of resistance to the eight drugs was OFX(64)>SM(62)>INH(48)>RFP(19)>CPM(2)>KM(1)>EMB(0)and PTO(0).The rate of resistance to INH and RFP of first-line drugs in newly treated patients was lower than that in retreated patients(χ^(2)=0.110,0.765;P>0.05);the rate of resistance to second-line drugs OFX,CPM and KM in initially treated patients was lower than that in retreated patients(χ^(2)=1.037,1.212,1.653;P>0.05).The total drug resistance rate in 2019 was 51.16%,which was higher than that in 2020(35.08%)and 2021(38.89%).The difference between groups was significant(χ^(2)=29.25,16.60;P=0.000),but there was no significant difference in overall drug resistance rate between 2020 and 2021(χ^(2)=1.823,P=0.177).Among the occupational types of tuberculosis patients,farmers were the main ones,accounting for 56.25%(949).The patients with drug-resistant tuberculosis were mainly distributed in Haikou City(165)>Wanning City(72)>Chengmai County(64)>Wenchang City(51)=Dongfang City(51)>Danzhou City(48),an

关 键 词：结核分枝杆菌 肺结核 耐药 药物敏感性试验 

分 类 号：R52[医药卫生—内科学]