海南省2018—2022年结核分枝杆菌耐药监测分析  

Surveillance of drug resistance to Mycobacterium tuberculosis in Hainan Province,2018-2022

作　　者：黄静静[1] 柯芊羽 侯萍 罗兴雄[1] HUANG Jingjing;KE Qianyu;HOU Ping;LUO Xingxiong(Department of Tuberculosis Prevention and Control,Infectious Disease Prevention and Control Institute,Hainan Provincial Center for Disease Control and Prevention,Haikou,Hainan 570203,China)

机构地区：[1]海南省疾病预防控制中心传染病预防控制所结核病预防控制科,海南海口570203

出　　处：《中国热带医学》2024年第1期102-106,共5页China Tropical Medicine

摘　　要：目的了解海南省2018—2022年结核分枝杆菌的耐药监测情况,分析全省结核分枝杆菌的耐药状况和变化趋势,为海南省制定结核病防治策略提供科学依据。方法对收集的肺结核患者痰培养阳性菌开展菌型鉴定和药敏试验,菌型鉴定采用对硝基苯甲酸(PNB)生长法,采用固体比例法对利福平(Rifampin,RFP)、异烟肼(Isoniazid,INH)、链霉素(Streptomycin,SM)、乙胺丁醇(Ethambutol,EMB)、氧氟沙星(Ofloxacin,OFX)、卡那霉素(Kanamycin,KM)等6种抗结核药物进行敏感性试验,并对药敏结果进行统计学分析。结果共收集肺结核患者痰培养阳性菌2481株,经菌型鉴定为结核分枝杆菌2211株,总耐药率为19.9%(441/2211),初治和复治患者耐药率分别为15.7%(271/1729)和35.3%(170/482),差异有统计学意义(χ^(2)=90.65,P<0.01);单耐药率为6.0%(132/2211),初治和复治患者单耐药率分别为5.6%(97/1729)和7.3%(35/482),差异无统计学意义(χ^(2)=1.83,P>0.05);总多耐药率为4.1%(91/2211),初治和复治患者多耐药率分别为3.5%(61/1729)和6.2%(30/482);总耐多药率为8.0%(176/2211),初治和复治患者耐多药率分别为4.2%(72/1729)和21.6%(104/482);经卡方检验,复治患者组的多耐药率和耐多药率均显著高于初治患者,差异有统计学意义(χ^(2)=6.94,155.98,P<0.01)。INH、RFP、SM、OFX、EMB和KM的耐药率分别为11.6%(257/2211)、11.4%(251/2211)、8.6%(191/2211)、8.2%(181/2211)、4.0%(88/2211)和1.6%(35/2211)。结论海南省复治患者结核分枝杆菌耐药率、耐多药率以及多耐药率均高于初治患者,结核病患者的规范治疗和管理尤为重要。Objective To understand the drug resistance surveillance situation of Mycobacterium tuberculosis in Hainan Province from 2018 to 2022,analyze the drug resistance status and trends of Mycobacterium tuberculosis in Hainan Province,and provide scientific basis for the formulation of tuberculosis prevention and treatment strategies.Methods A total of 2481 sputum culture-positive isolates from pulmonary tuberculosis patients collected from 2018 to 2022 were subjected to strain identification and drug sensitivity testing.Strain identification was performed using the p-nitrobenzoic acid(PNB)inhibition test,and the sensitivity test for six anti-tuberculosis drugs,including Rifampicin(RFP),Isoniazid(INH),Streptomycin(SM),Ethambutol(EMB),Ofloxacin(OFX),and Kanamycin(KM),was conducted using the solid culture proportion method.The drug sensitivity results were statistically analyzed.Results Of the 2481 isolates,2211 were identified as Mycobacterium tuberculosis complex(MTBC).The overall drug-resistance rate was 19.9%(441/2211).The drug resistance rates for initialtreatment and retreatment patients were 15.7%(271/1729)and 35.3%(170/482)respectively,with a statistically significant difference(χ^(2)=90.65,P<0.01).The mono-resistance rate(MR)was 6.0%(132/2211),with monoresistance rates of 5.6%(97/1729)for initial-treatment patients and 7.3%(35/482)for retreatment patients,with no statistically significant difference(χ^(2)=1.83,P>0.05).The overall poly-resistance rate(PR)was 4.1%(91/2211),with polyresistance rates of 3.5%(61/1729)for initial-treatment patients and 6.2%(30/482)for retreatment patients.The overall multidrug-resistance rate(MDR)was 8.0%(176/2211),with multidrug resistance rates of 4.2%(72/1729)for initial-treatment patients and 21.6%(104/482)for retreatment patients.According to theχ^(2) test,the retreatment group had significantly higher rates of polyresistance and multidrug resistance than the initial-treatment patient group,with statistically significant differences(χ^(2)=6.94,P<0.01;χ^(2)=155.98,P<0.01).The

关 键 词：分枝杆菌 结核 初治 复治 多耐药结核病 耐多药结核病 

分 类 号：R521.1[医药卫生—内科学]