摘要
目的了解抚州市结核病耐药性的流行特征,分析耐药情况。方法收集2015—2019年抚州市各区县送检的涂阳肺结核患者临床分离菌株528株,经对硝基苯甲酸(PNB)、噻吩二羧酸肼(TCH)鉴定为结核分枝杆菌491株,采用固体比例法进行药敏试验,用Excel 2010、SPSS 21.0统计软件进行数据分析。结果结核分枝杆菌491株,耐药菌株80株,总耐药率为16.29%,其中2015年总耐药率最高、为21.43%,2016年最低、为12.00%,各年度结核分枝杆菌总耐药率比较差异无统计学意义(P>0.05)。初治总耐药率为14.71%,复治总耐药率为50.00%,初治与复治总耐药率比较差异有统计学意义(χ^(2)=19.186,P<0.001)。不同性别之间总耐药率比较差异无统计学意义(P>0.05),但男性患者中初治与复治总耐药率比较差异有统计学意义(χ^(2)=19.046,P<0.001)。40~59岁患者总耐药率最高、为18.18%,0~19岁患者总耐药率最低、为14.29%,各年龄段总耐药率比较差异无统计学意义(P>0.05)。单一药物耐药菌株占比60.00%(48/80),总耐药率为9.78%(48/491),其中一线药物单耐药率顺位链霉素(SM,2.65%)>异烟肼(INH,2.04%)>利福平(RFP,1.22%)>乙胺丁醇(EMB,0.00%),二线药物的单一药物耐药氧氟沙星(OFX,3.67%)高于卡那霉素(KM,0.20%)。多耐药率和耐多药率均为3.26%,广泛耐多药率为0.81%;多耐药中以耐INH+SM组合为最高,耐多药中以耐INH+RFP、INH+RFP+SM为主;耐RFP菌株中耐多药率为59.26%。结论抚州市结核病总耐药率、多耐药率、耐多药率和耐RFP中的耐多药率相对处于较低水平,要继续实施好现代结核病控制策略,规范使用抗结核药物,提高初治患者治愈率与复治患者管理水平,特别是要高度重视中老年复治患者耐药率高的问题,从而减少耐药结核病的传播。
Objective To understand the epidemic characteristics of tuberculosis drug resistance and to analyze the drug resistance in Fuzhou.Methods A total of 528 isolates were collected from smear-positive pulmonary tuberculosis patients in Fuzhou from 2015 to 2019.Of these isolates,491 strains of Mycobacterium tuberculosis were identified by p-nitrobenzoic acid and thiophen-2-carboxylic acid hydrazide.The drug sensitivity test was performed by solid proportion method.The data were analyzed using Excel 2010 and SPSS 21.0 softwares.Results Totally 80 drug-resistant strains(16.29%)were found among the 491 isolates of Mycobacterium tuberculosis.The drug resistance rate was highest in 2015(21.43%),and lowest in 2016(12.00%).There was no significant difference in drug resistance rate among different years(P>0.05).The retreatment drug resistance rate(50.00%)was higher than the initial drug resistance rate(14.71%)(χ^(2)=19.186,P<0.001).No significant difference in drug resistance rate was observed between different genders(P>0.05).However,the initial drug resistance rate was significantly different from the retreatment drug resistance rate in male patients(χ^(2)=19.046,P<0.001).The drug resistance rate was highest among patients aged 40-59 years(18.18%),and lowest among patients aged 0-19 years(14.29%).There was no significant difference in drug resistance rate among different age groups(P>0.05).Single drug-resistant strains accounted for 60.00%(48/80),and the drug resistance rate was 9.78%(48/491).The single first-line drug resistance rate was the highest for streptomycin(SM,2.65%),followed by isoniazid(INH,2.04%),rifampicin(RFP,1.22%)and ethambutol(EMB,0.00%).The single second-line drug resistance rate for ofloxacin(3.67%)was higher than that for kanamycin(0.20%).Both multiple drug-resistance rate and multi-drug resistance rate were 3.26%.The extensive multi-drug resistance rate was 0.81%.Multiple drug-resistance rate was the highest for INH+SM.Multi-drug resistant tuberculosis was mainly resistant to INH+RFP and INH+RFP+SM.The multi-drug resistance rate was 59.26%in RFP-resistant strains.Conclusion The total drug resistance rate,multiple drug-resistance rate,multi-drug resistance rate and rate of multi-drug resistance to RFP are relatively low among Mycobacterium tuberculosis isolates from patients in Fuzhou.Therefore,modern tuberculosis control strategies and standardized use of anti-tuberculosis drugs should be implemented to improve the cure rate of newly treated patients and the management of re-treated patients.Particularly,attention should be paid to the high drug resistance rate in middle-aged and elderly re-treated patients to reduce the spread of drug-resistant tuberculosis.
作者
严樟华
徐弢
周见军
饶武敏
李小慧
YAN Zhang-hua;XU Tao;ZHOU Jian-jun;RAO Wu-min;LI Xiao-hui(Department of Clinical Laboratories,Fuzhou Center for Disease Control and Prevention,Fuzhou 344000,China)
出处
《实用临床医学（江西）》
CAS
2021年第2期68-73,共6页
Practical Clinical Medicine
基金
抚州市指导性科技计划项目(抚科计字[2019]4号-09)。
关键词
肺结核
结核分枝杆菌
耐药
江西
抚州
Tuberculosis
Mycobacterium tuberculosis
Drug resistance
Jiangxi,Fuzhou
