2015-2018年陕西某医院结核分枝杆菌耐药趋势分析

目的 分析本院结核分枝杆菌的耐药情况及趋势，为耐药结核病的预防及治疗提供参考依据。方法 对2015-2018年本院门诊、住院病人，共9050例结核分枝杆菌的一线和二线抗结核药物耐药情况进行回顾性分析。结果:四年中，本院结核菌培养的阳性率有所上升，但是总体耐药率基本不变（平均35.03%）。单耐药的耐药率有所下降（〖XC小五号.EPS;P〗=13.76，P=0.003），而耐多药和一线4种耐药的耐药率有所上升（耐多药〖XC小五号.EPS;P〗=19.84，P<0.001；一线4种耐药〖XC小五号.EPS;P〗=18.97，P<0.001）。异烟肼、链霉素、乙胺丁醇、利福平、阿米卡星和丙硫异烟胺的耐药率都有所上升（分别为〖XC小五号.EPS;P〗=12.57，P=0.006；〖XC小五号.EPS;P〗=17.02，P=0.001；〖XC小五号.EPS;P〗=13.68，P=0.003；〖XC小五号.EPS;P〗=25.60，P<0.001；〖XC小五号.EPS;P〗=12.82，P=0.005；〖XC小五号.EPS;P〗=11.19，P=0.011）。结论 单耐药减少，但耐多药和任意药物的耐药率增加，显示结核菌耐药形势严峻，应加强合理治疗和管理患者，并加快新药研发。

Mycobacterium tuberculosis drug resistance trend in a hospital of Shaanxi, 2015-2018

Objective To analyze the situation and trend on drug resistance of mycobacterium tuberculosis(TB) in hospital, and to provide reference for the prevention and treatment of drug-resistant tuberculosis. Methods Retrospective analysis of the first-line and second-line anti-tuberculosis drug resistance was conducted, with 9050 cases of patients in our hospital from 2015 to 2018. Results From 2015 to 2018, the positive rate of TB culture in our hospital increased, but the overall drug resistance rate basically remained unchanged(35.03% on average). The single-drug resistance rate decreased(X2=13.76, P=0.003), while the multi-drug resistance and first-line 4 drugs resistance rates increased(X2=19.84, P<0.001; X2=18.97, P<0.001). The drug resistance rates of isoniazid, streptomycin, ethambutol, rifampicin, amikacin and prothionamide all increased(X2=12.57, P=0.006; X2=17.02, P=0.001; X2=13.68, P=0.003; X2=25.60, P<0.001; X2=12.82, P=0.005; X2=11.19, P=0.011, respectively). Conclusion Reduction of rate of the single-drug resistance and increase of rates of multi-drug resistance and many drugs suggest that the situation of TB drug resistance is severe. Therefore, rational treatment and management of patients should be strengthened, and the development of new drugs should be accelerated.