石家庄市2011-2020年非结核分枝杆菌耐药性监测结果分析  

Analysis of drug resistance monitoring results of non-tuberculous Mycobacteria in Shijiazhuang City from 2011 to 2020

作　　者：周吉坤[1] 朱建良[1] 郭付爱[1] 刘维华[1] 张洁[1] 陈城戌 ZHOU Jikun;ZHU Jianliang;GUO Fuai;LIU Weihua;ZHANG Jie;CHEN Chengxu(Shijiazhuang Center for Disease Control and Prevention,Shijiazhuang,Hebei 050000,China)

机构地区：[1]石家庄市疾病预防控制中心,河北石家庄050000

出　　处：《医学动物防制》2024年第3期258-261,265,共5页Journal of Medical Pest Control

基　　金：河北省医学适用技术跟踪项目计划(G2018113)。

摘　　要：目的 分析石家庄市2011-2020年病原学阳性的肺结核患者中菌株鉴定及非结核分枝杆菌耐药性监测结果,为结核病防治策略提供科学依据。方法 对石家庄市2011-2020年确诊登记的病原学阳性肺结核患者的菌株鉴定和耐药筛查结果进行整理和描述性分析。结果 6 372例病原学阳性肺结核患者的菌株中,非结核分枝杆菌206例,占3.23%。其中复治患者非结核分枝杆菌占7.51%、初治患者占2.52%,两者差异有统计学意义(χ^(2)=61.632,P<0.001);涂片阳性患者非结核分枝杆菌检出率为3.19%,涂片阴性患者为3.31%,两者差异无统计学意义(χ^(2)=0.062,P=0.803)。206例非结核分枝杆菌患者的地区分布差异有统计学意义(χ^(2)=88.285,P<0.001),最高占7.74%,最低为0%。非结核分枝杆菌的总耐药情况:异烟肼(isoniazid, INH)耐药率为86.41%、链霉素(streptomycin, SM)耐药率为73.30%、利福平(rifampicin, RFP)耐药率为57.28%、乙胺丁醇(ethambutol, EMB)耐药率为48.06%、氧氟沙星(ofloxacin, OFX)耐药率为54.85%、卡那霉素(kanamycin, KM)耐药率为63.11%;6种药全耐53例,占25.73%,6种药全敏感27例,占13.11%。对一线抗结核药(INH、RFP、EMB、SM)全耐70例,占33.98%,全敏感27例,占13.11%。结论 应高度重视非结核分枝杆菌病与病原学阳性肺结核的鉴别诊断,治疗应结合药敏实验结果和临床效果制定合理的治疗方案。Objective To analyze the results of strain identification and non-tuberculous Mycobacteria drug resistance surveillance among pathogenetically positive tuberculosis patients in Shijiazhuang City from 201l to 2020,providing a scientific basis for TB control strategies.Methods The results of strain identification and drug resistance screening results of pathogenetically positive tuberculosis patients diagnosed and registered were collated and descriptively analyzed from 2011 to 2020 in Shijazhuang City.Results Among 6372 pathogenetically tuberculosis patients positive strain,206 were non-tuberculous Mycobacteria,accounting for 3.23%.Non-tuberculous Mycobacteria accounted for 7.51%in retreated patients and 2.52%in new treatment cases,with a statistically significant difference(x^(2)=61.632,P<0.001).Smear-positive patients had a non-tuberculous Mycobacteria rate of 3.19%,while smear-negative patients had a rate of 3.31%,with no statistically significant difference(x^(2)=0.062,P=0.803).The regional distribution of 206 non-tuberculous Mycobacterium patients varied with a statistically significant diference(X2=88.285,P<0.001),ranging from the highest at 7.74%to the lowest at 0%.The total drug resistance of non-tuberculous Mycobacteria was as follows:isoniazid(INH)resistance rate was 86.41%,streptomycin(SM)resistance rate was 73.30%,rifampicin(RFP)resistance rate was 57.28%,ethambutol(EMB)resistance rate was 48.06%,ofloxacin(OFX)resistance rate was 54.85%,and kanamycin(KM)resistance rate was 63.11%.Fifty-three cases(25.73%)exhibited resistance to all six drugs,while 27 cases(13.11%)were susceptible to all six drugs.Additionally,70 cases were fully resistant to first-line antituberculosis drugs(INH,RFP,EMB,SM),accounting for 33.98%,while 27 cases(13.11%)demonstrated total sensitivity.Conclusion We should pay great attention to the differential diagnosis between non-tuberculous mycobacterial disease and pulmonary tuberculosis with positive etiology,and make reasonable treatment plan according to the results of drug sensiti

关 键 词：肺结核 病原学阳性 菌株鉴定 结核分枝杆菌 非结核分枝杆菌 耐药率 

分 类 号：R521[医药卫生—内科学]