摘要
目的:分析2016—2022年安徽省4个国家级结核病耐药监测点分离的结核分枝杆菌的耐药谱变化趋势,从而掌握安徽省结核病和耐药结核病的流行和防控效果。方法:连续纳入2016—2022年4个耐药监测点的病原学阳性肺结核患者3073例,采集患者的基本信息并收集痰标本进行分离培养,培阳菌株进行菌种鉴定,共获得结核分枝杆菌2336株,采用比例法对结核分枝杆菌开展6种抗结核药物[异烟肼(INH)、利福平(RFP)、链霉素(Sm)、乙胺丁醇(EMB)、氧氟沙星(Ofx)和卡那霉素(Km)]的药物敏感性试验。结果:2336株结核分枝杆菌菌株中,有1893株(81.04%)对6种抗结核药物全部敏感,443株对至少1种或更多抗结核药物耐药,耐药率为18.96%(443/2336),其中初治为16.80%(348/2071),复治为35.85%(95/265),耐多药菌株98株(4.20%)。在6种抗结核药物中,抗结核药物单耐药率由高到低分别为:INH(10.55%,236/2336)、Sm(8.18%,183/2336)、Ofx(6.53%,146/2336)、RFP(5.95%,133/2336)、EMB(2.37%,53/2336)、Km(1.97%,44/2336)。2016—2022年,抗结核药物Ofx、INH、EMB和Km耐药率[2016年分别为10.49%(30/286)、12.24%(35/286)、1.75%(5/286)、2.45%(7/286),2022年分别为3.89%(18/463)、9.29%(43/463)、0.86%(4/463)、1.08%(5/463)]呈下降趋势(χ^(2)_(趋势)值分别为16.964、15.989、15.798、26.075,P值均<0.05),初治患者的耐药率和多耐药率[2016年分别为22.76%(56/246)、6.50%(16/246),2022年分别为14.15%(60/424)、1.89%(8/424)]也呈下降趋势(χ^(2)_(趋势)值分别为14.445、16.688,P值均<0.05);在不同年龄段中,40~59岁年龄段结核分枝杆菌菌株的耐药率(22.74%,146/642)最高。结论:安徽省结核病的耐药形势依然严峻,复治患者、40~59岁人群和城镇地区患者结核病耐药问题需要重点关注。
Objective:To analyze the change trend of drug resistance spectrum of Mycobacterium tuberculosis isolated from four national drug resistance monitoring sites in Anhui Province from 2016 to 2022,and then to understand the prevalence and control effect of tuberculosis and drug-resistant tuberculosis in Anhui Province.Methods:A total of 3073 laboratory-confirmed pulmonary tuberculosis patients,who were continuously enrolled from four drug resistance surveillance sites between 2016 and 2022,were included in the study.General information of the patients was collected,and sputum specimens were collected for isolation and cultured.Strain identification was performed on the cultured isolates,and a total of 2336 strains of Mycobacterium tuberculosis were obtained.Drug susceptibility testing was performed on the Mycobacterium tuberculosis strains using the proportion method for six anti-tuberculosis drugs(isoniazid(INH),rifampicin(RFP),streptomycin(Sm),ethambutol(EMB),ofloxacin(Ofx),and kanamycin(Km).Results:Among the 2336 strains of Mycobacterium tuberculosis,1893 strains(81.04%)were sensitive to all the six anti-tuberculosis drugs,and 443 strains were resistant to at least one or more anti-tuberculosis drugs,with a drug resistance rate of 18.96%(443/2336),of which 16.80%(348/2071)were newly treated,35.85%(95/265)were retreated,and 98(4.20%)were multidrug resistant.Among the six anti-tuberculosis drugs,the prevalence of single resistance to anti-tuberculosis drugs were decreased from INH(10.55%,236/2336)to Sm(8.18%,183/2336),Ofx(6.53%,146/2336),RFP(5.95%,133/2336),EMB(2.37%,53/2336),Km(1.97%,44/2336).The resistance rates to Ofx,INH,EMB and Km showed a downward trend from 2016 to 2022(the resistance rates of Ofx,INH,EMB and Km were 10.49%(30/286),12.24%(35/286),1.75%(5/286)and 2.45%(7/286)in 2016,respectively;3.89%(18/463),9.29%(43/463),0.86%(4/463),1.08%(5/463)in 2022);χ^(2)_(trend)values were 16.964,15.989,15.798,and 26.075,respectively,all Ps<0.05).The drug resistance rate and multidrug-resistance rate of newly diagnosed patients(22.76%(56/246)and 6.50%(16/246)in 2016,14.15%(60/424)and 1.89%(8/424)in 2022)also showed a downward trend(χ^(2)_(trend)=14.445,16.688,All Ps<0.05).Among different age groups,the drug resistance rate of Mycobacterium tuberculosis strains in the 40-59 years old group was the highest(22.74%,146/642).Conclusion:The situation of drug resistance tuberculosis is still serious in Anhui province.More attention should be paid to drug resistance in retreatment patients,people aged 40-59 years and patients living in urban areas.
作者
包训迪
梁锁
李军
叶倩
吴丹丹
王舒
李跃
丁运生
刘洁
Bao Xundi;Liang Suo;Li Jun;Ye Qian;Wu Dandan;Wang Shu;LI Yue;Ding Yunsheng;Liu Jie(Anhui Provincial Chest Hospital(Provincial Institute of Tuberculosis Control),Hefei 230022,China)
出处
《中国防痨杂志》
CAS
CSCD
北大核心
2024年第5期531-537,共7页
Chinese Journal of Antituberculosis
基金
安徽省胸科医院科研项目(2020kj018B)。
关键词
分枝杆菌
结核
抗药性
细菌
人群监测
Mycobacterium tuberculosis
Drug resistance,bacterial
Population surveillance
