摘要
目的对南通市涂阳肺结核患者进行5年的耐药性监测，对耐药率和耐药谱进行分析，为制定南通市结核病防控策略提供科学依据。方法2009年10月1日至2014年6月30日，南通市7家结核病定点医疗机构共确诊18256例肺结核患者，对其中2776例痰涂片阳性的初、复治患者进行分枝杆菌培养、菌种鉴定，对培养成功的1893株结核分枝杆菌菌株采用比例法对异烟肼（H）、利福平（R）、乙胺丁醇（E）、链霉素（S）、氧氟沙星（Ofx）和卡那霉素（Kin）等6种抗结核药物进行药物敏感性试验（简称“药敏试验”）。结果南通市结核分枝杆菌的总耐药率、单耐药率、多耐药率、耐多药率分别为21．34％（404／1893）、5．86％（111／1893）、3．17％（60／1893）、12．31％（233／1893）；复治患者的总耐药率、单耐药率、多耐药率、耐多药率分别为45．74％（252／551）、8．17％（45／551）、4．54％（25／551）、33．03％（182／551），均高于初治患者[11．33％（152／1342）、4．92％（66／1342）、2．61％（35／1342）、3．80％（51／1342）I，矿值和P值分别为：总耐药率（X^2=275．50，P=O．000）、单耐药率（X^2=7．47，P=0．006）、多耐药率（X^2=4．74，P=0．030）、耐多药率（zX^2=309．22，P=0．000），差异均有统计学意义。对404例耐药患者进行上述6种药物的药敏试验，共有29种耐药谱组合。其中单耐药有6种组合，对单一耐S构成比最高，为40．55％（45／111）；其次是单一耐H，占33．33％（37／111）。多耐药有14种组合，以耐H＋s构成比最高（41．67％，25／60）；其次是耐R＋S（13．33％，8／60）。耐多药有10种组合，以耐H＋R＋S构成比最高（35．62％，83／233）；其次是耐H＋R（34．76％，81／233）。初、复治涂阳患者中均有耐二线药物的组合；对S耐药的初、复治患者中，顺位分别是第2位（86例）和第3位（128例）。结论南通市耐多药结核病疫情防控形势不容乐观，应进一步强化以DOTS策略为基础的现代结核病控制策略，提高结核病患者诊断、治疗和管理质量，减少复治患者的产生，从而减少耐多药结核病患者的出现。
Objective To provide scientific basis for the development of strategies of tuberculosis prevention and control in Nantong city, by monitoring the drug-resistance on smear-positive tuberculosis patients in Nantong city for 5 years, and analyzing the drug-resistant rate and spectrum. Methods There were 18 256 patients diagnosed as tuberculosis in the 7 designated medical institution for tuberculosis in Nantong city between October 1, 2009 and June 30, 2014. We did mycobacterium culture and strain identification for the 2776 sputum smear positive patients in their initial/re-treatment. For the 1893 successfully cultured myeobacterium strain, we used proportional method to do the drug sensitivity test for the 6 anti-tuberculosis drugs： isoniazid （H）, rifampiein （R）, ethambutol （E）, streptomycin （S）, ofloxaein （Ofx） and kanamycin （Kin）. Results The total drug resistant rate, single drug resistant rate, multi drug resistant rate, and multidrug-resistant rate were 21.34% （404/1893）, 5.86% （111/1893）, 3.17% （60/1893）, 12.31% （233/1893） respectively for mycobacterium tuberculosis in Nantong. The rates were 45.74% （252/551）, 8.17% （45/551）, 4. 54% （25/551）, and 33. 03% （182/551） in retreatment patients, which were all higher than the initial treatment patients （11.33%（152/1342）, 4. 92% （66/1342）, 2. 61% （35/1342）, and 3.80% （51/1342））. The statistical differences between these 2 groups were： total drug resistant rate （X^2=275.50, P = 0. 000）, single drug resistant rate （X^2=7. 47, P = 0. 006）, multi drug resistant rate （X^2=4. 74,P=0. 030）, and multidrug-resistant rate （X^2=309.22, P= 0. 000）. The differences were statistically signifi-cant. By doing the drug sensitivity test for the 6 anti-tuberculosis drugs on the 404 drug resistant patients, there were in total 29 combination of drug resistance spectrum. There were 6 combinations of single drug resistance, from which the S-resistance constitutes the highest, which was 40.55% （45/111）, and the H-resistance comes next with 33.33% （37/111）. There were 10 combinations for multidrug-resistance, from which the Hq-Rq-S resistance con- stituted the highest （35.62%, 83/z33） and H-I-R resistance came next （34. 76%, 81/233）. There were second-line drug resistance combinations for both initial/re-treatment patients. For S-resistance patients, the orders were the 2nd （86 cases） and the 3rd（128 cases）. Conclusion The prevention and control of tuberculosis epidemic situation in Nantong is not optimistic. The contemporary tuberculosis control strategy based on DOTS strategy should be strengthened, thus to improve the quality of diagnosis, treatment and management of the tuberculosis patients, and reduce the number of retreatment patients, and eventually reduce the number of tuberculosis patients with multi- drug-resistance.
出处
《中国防痨杂志》
CAS
2016年第11期945-950,共6页
Chinese Journal of Antituberculosis
基金
南通市社会发展事业科技创新与示范项目（HS149001）
第七轮中国全球基金结核病项目（CHN-708-G11-T）
关键词
分枝杆菌
结核
抗药性
多种
细菌
药物监测
数据说明
统计
小地区分析
Mycobacteria, tuberculosis
Drug resistance, multiple, bacteria
Drug monitoring
Data interpretation, statistical
Small-area analysis
