610例老年结核病患者临床分离株耐药情况分析  

Analysis of drug resistance in clinical isolates from 610 elderly tuberculosis patients

作　　者：许河南 赖聪娟 张尊敬[2] 郭净 徐丽霞 张颖 刘忠达 Xu Henan;Lai Congjuan;Zhang Zunjing;Guo Jing;Xu Lixia;Zhang Ying;Liu Zhongda(Department of Clinical Laboratory Medicine,Lishui Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine,Lishui 323000,China;Department of Tuberculosis,Lishui Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine,Lishui 323000,China;State Key Laboratory of Infectious Diseases Diagnosis and Treatment,The First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江中医药大学附属丽水中医院检验科,丽水323000 [2]浙江中医药大学附属丽水中医院结核病科,丽水323000 [3]浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003

出　　处：《中国防痨杂志》2024年第12期1490-1495,共6页Chinese Journal of Antituberculosis

基　　金：浙江省中医药科技计划项目(2023ZL801);国家中医药管理局-浙江中医药管理局共建科技计划项目(GZY-ZJ-KJ-23096)。

摘　　要：目的:了解浙江省丽水市某结核病定点医院老年结核病患者(≥60岁)结核分枝杆菌临床分离株耐药特征,为本区域老年耐药结核病防控工作提供参考。方法:收集2018—2023年丽水地区结核病定点医院就诊的老年结核病患者临床分离株和样本信息,采用BACTEC MGIT 960结核分枝杆菌液体药物敏感性试验检测一线抗结核药物(链霉素、异烟肼、利福平、乙胺丁醇)耐药性并分析耐药特征。结果:共610株结核分枝杆菌纳入耐药检测和分析,总耐药率为18.85%(115/610),耐多药率为6.07%(37/610)。男性患者耐药率为19.38%(93/480),女性患者耐药率为16.92%(22/130),差异无统计学意义(χ^(2)=0.402,P>0.05)。初治患者耐药率为18.18%(98/539),复治患者耐药率为23.94%(17/71),其中,复治患者对乙胺丁醇的耐药率[8.45%(6/71)]明显高于初治患者[2.78%(15/539)],差异有统计学意义(χ^(2)=6.063,P<0.05)。耐药率由高到低依次为异烟肼[14.59%(89/610)]、链霉素[8.85%(54/610)]、利福平[7.38%(45/610)]、乙胺丁醇[3.44%(21/610)]。共有13种不同的耐药组合,其中,耐多药组合以“异烟肼+利福平+链霉素”耐药率最高,为2.62%(16/610)。2018年耐药率为20.00%(19/95),降低至2023年的17.83%(23/129),差异无统计学意义(χ^(2)趋势=1.792,P>0.05)。结论:丽水地区老年结核病患者结核分枝杆菌临床分离株耐药率近年有所下降,但耐药情况依然严峻。Objective:To analyze the drug resistance characteristics of clinical isolates of Mycobacterium tuberculosis(MTB)in elderly tuberculosis patients(≥60 years old)in a tuberculosis designated hospital in Lishui City,Zhejiang Province,China,offering insights for the prevention and control of drug-resistant tuberculosis in the elderly population of the region.Methods:Information on clinical isolates and samples from elderly tuberculosis patients visiting the Lishui Regional Tuberculosis Sentinel Hospital from 2018 to 2023 was collected.Resistance to first-line antituberculosis drugs(streptomycin,isoniazid,rifampicin,ethambutol)was detected using BACTEC MGIT 960 liquid drug susceptibility test and resistance characteristics were analyzed.Results:A total of 610 strains of MTB were included in the drug resistance detection and analysis.The overall drug resistance rate was 18.85%(115/610),and the multidrug resistance rate was 6.07%(37/610).The drug resistance rate of male patients was 19.38%(93/480),and that of female patients was 16.92%(22/130),with no statistically significant difference(χ^(2)=0.402,P>0.05).The drug resistance rate among initial treatment patients was 18.18%(98/539),and that of retreated patients was 23.94%(17/71).Among them,the ethambutol resistance rate among retreated patients(8.45%(6/71))was significantly higher than that among initial treatment patients(2.78%(15/539),χ^(2)=6.063,P<0.05).The resistance rates for different drugs ranked as:isoniazid(14.59%,89/610),streptomycin(8.85%,54/610),rifampicin(7.38%,45/610),and ethambutol(3.44%,21/610).The drug resistance patterns showed a total of 13 different drug resistance combinations.Among multidrug resistance combinations,the highest drug resistance rate was for“isoniazid+rifampicin+streptomycin”(2.62%,16/610).The drug resistance rate was 20.00%(19/95)in 2018 and 17.83%(23/129)in 2023,with no statistically significant difference for changing trend(χ^(2)trend=1.792,P>0.05).Conclusion:The drug resistance rate of MTB in elderly tuberculosis patient

关 键 词：分枝杆菌 结核 老年人 结核 抗多种药物性 药物敏感性试验 

分 类 号：R52[医药卫生—内科学] R446.5[医药卫生—临床医学]