118例骨关节结核耐药情况分析  

Analysis of drug resistance in 118 cases with bone and joint tuberculosis

作　　者：王潮虹 孙晴 廖鑫磊 晏君 龙嗣博 郑迈克 赵艳 王桂荣[1] Wang Chao-Hong;Sun Qing;Liao Xin-Lei;Yan Jun;Long Si-Bo;Zheng Mai-Ke;Zhao Yan;Wang Gui-Rong(Department of Clinical Laboratory,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院检验科,北京101149

出　　处：《解放军医学杂志》2023年第9期1055-1060,共6页Medical Journal of Chinese People's Liberation Army

基　　金：北京市高层次公共卫生技术人才项目(2022-3-040);北京市通州区科技计划项目(KJ2022CX044);北京市通州区“两高”人才工程(YH201917)。

摘　　要：目的分析118例骨关节结核住院患者的耐药特点。方法回顾性分析2016年1月-2022年6月首都医科大学附属北京胸科医院收治的118例骨关节结核住院患者的临床资料。采用药敏试验检测来自118例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)、左氧左旋氧氟沙星(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,分析骨关节结核患者的结核分枝杆菌培养结果、药敏试验结果、初治或复治情况,以及病原学确诊为骨关节结核初治与复治患者耐药类型的差异。结果118例骨关节结核患者对16种抗结核药的总耐药率为28.0%(33/118),复治患者的总耐药率明显高于初治患者,差异有统计学意义[70.0%(21/30)vs.13.6%(12/88),P<0.001]。118例骨关节结核患者任一耐药率顺位前7位为Sm、INH、RFP、Rft、Rfb、Pa和Clr,初治患者任一耐药率顺位前7位为Sm、INH、Clr、Pa、RFP、Rft和PAS,复治患者任一耐药率顺位前7位为Sm、RFP、Rft、Rfb、INH、Pa和EMB。118例骨关节结核患者的总单耐药率、总多耐药率、总耐多药率依次为7.6%(9/118)、8.5%(10/118)、11.9%(14/118)。初治患者与复治患者的单耐药率差异无统计学意义[6.8%(6/88)vs.10.0%(3/30),P=0.691],复治患者多耐药率和耐多药率明显高于初治患者[20.0%(6/30)vs.4.5%(4/88),P=0.017;40.0%(12/30)vs.2.3%(2/88),P<0.001]。结论骨关节结核耐药问题严重,临床医师在行手术治疗的同时,应根据药敏试验结果制定有效的药物治疗方案。Objective To analyze the drug resistance features of 118 patients with bone and joint tuberculosis.Methods The clinical data of 118 joint tuberculosis patients who were hospitalized in Beijing Chest Hospital from January 2016 to January 2022 were retrospectively analyzed.Drug susceptibility test was performed for the following 16 drugs 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).Analyze the Mycobacterium tuberculosis culture results,drug sensitivity results,initial or retreatment status of patients with bone and joint tuberculosis,as well as the drug resistance types of patients diagnosed with bone and joint tuberculosis by etiology.Results The total drug resistance rate of 118 bone and joint tuberculosis patients to at least one of the 16 drugs was 28.0%(33/118),of which the drug resistance rate was significantly higher in previously treated patients than in new patients with statistically significant difference[70.0%(21/30)vs.13.6%(12/88),P<0.001].The top seven drug resistance rate of bone and joint tuberculosis to the 16 drugs were:Sm,INH,RFP,Rft,Rfb,Pa and Clr,and the top seven drug resistance rates of new patients were:Sm,INH,Clr,Pa,RFP,Rft and PAS,and the top seven drug resistance rates of in previously treated patients were:Sm,RFP,Rft,Rfb,INH,Pa and EMB.The mono-resistance rate of bone and joint tuberculosis,poly-drug resistance rate of spinal tuberculosis,and multidrug-resistance rate were 7.6%(9/118),8.5%(10/118),and 11.9%(14/118),respectively.There was no significant difference of the mono-resistance rate of bone and joint tuberculosis between new patients and in previously treated patients[6.8%(6/88)vs.10.0%(3/30),P=0.691],but the poly-drug resistance rate and the multidrug-resistance rate were significantly higher in previously treated patients than in new pa

关 键 词：结核 骨关节 药物敏感性试验 耐药性 耐多药 

分 类 号：R529.2[医药卫生—内科学]