2014—2022年德阳市结核分枝杆菌耐药情况分析  

Analysis on drug resistance of mycobacterium tuberculosis in Deyang City from 2014 to 2022

作　　者：杨国庆 何杨[1] 杨曦霞 吴晓宇 伍剑[1] 黄文静 YANG Guoqing;HE Yang;YANG Xixia;WU Xiaoyu;WU Jian;HUANG Wenjing(Deyang Center for Disease Control and Prevention,Deyang 618000,Sichuan Province,China)

机构地区：[1]德阳市疾病预防控制中心,四川德阳618000

出　　处：《预防医学情报杂志》2024年第9期1173-1178,共6页Journal of Preventive Medicine Information

基　　金：德阳市科技计划重点研发项目(项目编号:2019SZ053)。

摘　　要：目的了解德阳市结核分枝杆菌对一线、二线抗结核药物的耐药状况,分析德阳市结核病耐药趋势和特点,为结核病防控管理、临床合理用药提供参考依据。方法收集和统计2014—2022年德阳市结核病患者信息,采用比例法对2014—2022年德阳市疾病预防控制中心结核病实验室收集痰培养分离的分枝杆菌菌株,进行4种一线抗结核药物(异烟肼INH、利福平RFP、链霉素SM、乙胺丁醇EMB)和2种二线抗结核药物(卡那霉素KM、氧氟沙星OFX)敏感性试验,并同时进行菌种鉴定,分析实验结果,耐药率比较采用χ^(2)检验,以P<0.05为差异有统计学意义。结果2014—2022年德阳市收集菌株共1229株,其中结核分枝杆菌(MTB)1182株,非结核分枝杆菌(NTM)45株,NTM阳性率为3.66%(45/1229)。MTB药物敏感性试验结果显示总耐药率为21.66%(256/1182),其中初诊患者耐药率为18.91%(198/1047),复诊患者耐药率为42.96%(58/135);总耐多药率为5.16%(61/1182),其中初诊患者耐多药率为3.92%(41/1047),复诊患者耐多药率为14.81%(20/135);历年耐药率依次为51.75%、27.33%、22.52%、13.38%、13.46%、14.14%、15.00%、17.12%和24.44%;历年耐多药率依次为11.40%、5.23%、7.95%、3.82%、3.85%、2.02%、2.50%、3.60%和5.56%;对4种一线抗结核药物INH、RFP、SM、EMB的耐药率分别为13.03%(154/1182)、6.26%(74/1182)、13.37%(158/1182)和2.62%(31/1182),对2种二线抗结核药物KM、OFX的耐药率分别为1.18%(14/1182)和4.23%(50/1182);单耐药率为12.27(145/1182),多耐药率为5.84%(69/1182),准广泛耐药率为1.10%(13/1182)。结论德阳市结核分枝杆菌耐药率较高,耐多药率高于四川省和广东省平均水平,近年来结核病耐药情况呈现回升的趋势,应继续加强结核病耐药筛查和监测,加强患者管理,科学用药,以控制耐药结核病的蔓延。Objective To investigate the drug resistance of Mycobacterium tuberculosis to first-line and second-line anti-tuberculosis drugs in Deyang City,to analyze the trend and characteristics of tuberculosis drug resistance in the city,and to provide reference for tuberculosis prevention and control management and clinical rational drug use.Methods The information of tuberculosis patients in Deyang City from 2014 to 2022 was collected and statistically analyzed.Mycobacterium strains isolated from sputum culture in tuberculosis laboratory of Deyang Center for Disease Control and Prevention from 2014 to 2022 were collected by proportional method.Sensitivity tests were conducted for four first-line anti-tuberculosis drugs(isoniazid INH,rifampicin RFP,streptomycin SM and ethambutol EMB)and two second-line anti-tuberculosis drugs(kanamycin KM and ofloxacin OFX).Strain identification was conducted at the same time.The experimental results were analyzed.The drug resistance rate was compared byχ^(2)test,and P<0.05 was considered statistically significant.Results A total of 1229 strains were collected in Deyang City from 2014to 2022,including 1182 Mycobacterium tuberculosis(MTB)and 45 non-tuberculous Mycobacterium(NTM).The positive rate of NTM was 3.66%(45/1229).The results of MTB drug sensitivity test showed that the total drug resistance rate was 21.66%(256/1182),among which the drug resistance rate was 18.91%(198/1047)in newly diagnosed patients and 42.96%(58/135)in revisiting patients.The total multidrug resistance(MDR)rate was 5.16%(61/1182),among which the MDR rate was 3.92%(41/1047)in newly diagnosed patients and 14.81%(20/135)in revisiting patients.The annual drug resistance rates were 51.75%,27.33%,22.52%,13.38%,13.46%,14.14%,15.00%,17.12%and 24.44%from 2014 to 2022,respectively.The MDR rates were11.40%,5.23%,7.95%,3.82%,3.85%,2.02%,2.50%,3.60%and 5.56%,respectively.The drug resistance rates of the four first-line anti-tuberculosis drugs,INH,RFP,SM and EMB,were13.03%(154/1182),6.26%(74/1182),13.37%(158/1182)and 2.62%(3

关 键 词：肺结核 结核分枝杆菌 药物敏感性试验 耐药率 耐药监测 

分 类 号：R378.91[医药卫生—病原生物学]