2017—2021年青海省结核分枝杆菌耐药现状及其特征分析  

Drug resistance and characteristics analysis of mycobacterium tuberculosis in Qinghai Province from 2017 to 2021

作　　者：王朝才[1] 刘燕[2] 蒋明霞[1] 晁秀珍 李尔琛 魏於家 祁晓芸 WANG Chao-cai;LIU Yan;JIANG Ming-xia;CHAO Xiu-zhen;LI Er-chen;WEI Yu-jia;QI Xiao-yun(Qinghai Provincial Center for Disease Control and Prevention,Xining,Qinghai 810000,China;不详)

机构地区：[1]青海省疾病预防控制中心,青海西宁810000 [2]青海大学医学部公共卫生系

出　　处：《现代预防医学》2024年第15期2844-2848,共5页Modern Preventive Medicine

基　　金：青海省“昆仑英才”行动计划[青人才字(2020)18号]。

摘　　要：目的分析青海省结核分枝杆菌对抗结核药物的耐药情况,为青海省结核病的诊断、治疗以及防控工作提供科学依据。方法选择2017—2021年青海省八个市(州)肺结核患者痰液中分离培养出的1836株阳性菌株,比例法用于药敏实验,检测异烟肼、利福平、链霉素、乙胺丁醇、氧氟沙星、卡那霉素共6种抗结核药物的耐药性。结果检测出耐药结核分枝杆菌462株,总耐药率为25.16%,初始耐药率为23.84%,获得性耐药率为38.89%,广泛耐药率为5.85%;6种抗结核药物的耐药率由高到低分别为异烟群、利福平、特霉素、乙胺丁醉、氧佩沙星、卡即電素,分别为15.74%、12.58%、12.58%、9.15%、5.56%、4.74%、1.63%。耐多药率为7.46%,初治耐多药率为5.97%,获得性耐多药率为22.84%。不同年份耐药率(χ2=25.645,P<0.001)和MDR率(χ2=13.578,P=0.009)均有差异;城市、农业区和牧业区的耐药率(χ2=16.865,P<0.001)和MDR(χ2=7.068,P=0.029)差异均有统计学意义。结论青海省分离出的结核杆菌耐多药率及二线药物耐药率均偏高,耐药率有逐年上升趋势,尤其是初始耐药率和耐多药率比例高;牧业区耐药率较高,提示应加强对结核病患者的规范治疗以及二线药物规范使用和病人的随访管理工作。Objective To analyze the drug resistance of Mycobacterium tuberculosis in Qinghai Province,to provide scientific basis for the diagnosis,treatment,and prevention and control of tuberculosis in Qinghai Province.Methods A total of 1836 culture-positive strains in pulmonary tuberculosis patients from eight cities(prefectures)in Qinghai Province from 2017 to 2021 were selected for drug resistance testing using the proportion method for isoniazid(I),rifampicin(R),streptomycin(S),ethambutol(E),ofloxacin(O),and kanamycin(K).Results Among the tested strains,462 were found to be drug-resistant,with an overall drug resistance rate of 25.16%.The primary drug resistance rate was 23.84%,and the acquired drug resistance rate was 38.89%.The rate of extensively drug-resistant tuberculosis was 5.85%.The drug resistance rates of the six anti-tuberculosis drugs from high to low were as follows:I(15.74%),S(12.58%),R(9.15%),E(5.56%),O(4.74%),and K(1.63%).The rate of multi-drug resistant tuberculosis(MDR-TB)was 7.46%,with a primary MDR rate of 5.97%and an acquired MDR rate of 22.84%.There were differences in drug resistance rates(χ2=25.645,P<0.001)and MDR rates(χ2=13.578,P=0.009)in different years,as well as differences in drug resistance rates(χ2=16.865,P<0.001)and MDR rates(χ2=7.068,P=0.029)among urban,agricultural,and pastoral areas.Conclusion The drug resistance rates of Mycobacterium tuberculosis isolated in Qinghai Province,especially the rates of primary drug resistance and MDR-TB,are relatively high,showing an increasing trend year by year.The drug resistance rates are particularly high in pastoral areas.This suggests the need to strengthen standardized treatment for tuberculosis patients,as well as the standardized use of second-line drugs and patient follow-up management.

关 键 词：青海省 结核分枝杆菌 耐药 

分 类 号：R52[医药卫生—内科学] R181.3[医药卫生—临床医学]