2019—2020年重庆市新定义广泛耐药结核病发生情况分析  

Occurrence of re-defined extensively drug-resistant tuberculosis in Chongqing Municipality in 2019—2020

作　　者：胡彦 吴成果 刘文果 冯鑫 沈静 孔珏颖 伏宣霖 詹建 朱大冕 HU Yan;WU Chengguo;LIU Wenguo;FENG Xin;SHEN Jing;KONG Jueying;FU Xuanlin;ZHAN Jian;ZHU Damian(Tuberculosis Reference Laboratory,Chongqing Institute for Tuberculosis Control,Chongqing 400050,China)

机构地区：[1]重庆市结核病防治所,重庆400050

出　　处：《中国预防医学杂志》2023年第9期922-927,共6页Chinese Preventive Medicine

基　　金：重庆市科卫联合医学科研项目(2022MSXM102,2022MSXM066)。

摘　　要：目的了解耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者对长程治疗方案核心药物的敏感性及新定义广泛耐药结核病病(extensively drug-resistant tuberculosis,XDR-TB)的发生情况,为MDR-TB患者合理选择用药及MDR-TB防治策略的制定提供依据。方法对保存的2019年1月—2020年6月期间来自重庆市39个区(县)的229例MDR-TB患者临床分离株传代培养后,采用微量肉汤稀释法对左氧氟沙星、莫西沙星、贝达喹啉及利奈唑胺进行药敏试验,分析其耐药情况。结果在229例MDR-TB患者中,左氧氟沙星和莫西沙星耐药率分别为31.00%(71/229)、30.57%(70/229),贝达喹啉、利奈唑胺的耐药率分别仅为4.37%(10/229)、1.31%(3/229)。按照新的XDR-TB定义,XDR-TB患者11例(4.80%),准广泛耐药结核病(pre-extensively drug-resistant tuberculosis,pre-XDR-TB)患者63例(27.51%),单纯MDR-TB患者155例(67.69%)。新定义下XDR-TB 11例非XDR-TB 218例;旧定义下XDR-TB 27例,非XDR-TB 202例,新旧定义下XDR-TB患者数差异有统计学意义(χ^(2)=7.346,P=0.007)。结论新定义下重庆市MDR-TB患者中XDR-TB发生率较低,贝达喹啉、利奈唑胺具有较强的体外抑菌活性,为MDR-TB的治疗带来了希望,但氟喹诺酮类药物较高的耐药率应引起重视。Objective To explore the susceptibility of to core drugs in long-term regimens and the occurrence of re-defined extensively drug-resistant tuberculosis(XDR-TB)in patients with multidrug-resistant tuberculosis(MDR-TB),so as to provide evidence for appropriate medication for MDR-TB and strategies on MDR-TB control.Methods The strains isolates from 229 MDR-TB patients from 39 districts(counties)in Chongqing municipality in the period from January 2019 to June 2020 was cultured.Broth microdilution method was performed to determine in vitro susceptibility of the isolates to levofloxacin(LFX),moxifloxacin(MFX),bedaquiline(BDQ)and linezolid(LZD).Results Among the isolates from 229 MDR-TB patients,31.00%(71/229)were resistant to LFX,30.57%(70/229)to MFX,and only 4.37%(10/229)and 1.31%(3/229)were resistant to BDQ and LZD,respectively.According to the new definition,11(4.80%)patients were XDR-TB,63(27.51%)were pre-extensively drug-resistant tuberculosis(pre-XDR-TB),and 155(67.69%)were simple MDR-TB.The number of XDR-TB patients based on the new definition was statistically significantly higher than that based on the prior definition(11 vs.27,χ^(2)=7.346,P=0.007).Conclusions Using the new definition,the incidence of XDR-TB among MDR-TB patients may be low in Chongqing.BDQ and LZD show good in vitro antibacterial activities,which may be promising drugs for MDR-TB,whereas the high incidence of resistance to fluoroquinolones in MDR-TB patients warrants close attention.

关 键 词：结核分枝杆菌 贝达喹啉 利奈唑胺 广泛耐药 

分 类 号：R446.5[医药卫生—诊断学]