武汉市1561例结核患者的耐药性分析

目的探讨武汉市2012年耐药结核病人耐药状况及耐药性发展趋势。方法收集武汉市结核病防治所检验科的痰结核培养阳性的标本,进行利福平(R)、异烟肼(H)、链霉素(S)、乙胺丁醇(E)、氧氟沙星(O)、卡拉霉素(K)的药敏试验,并通过菌型鉴定,确定结核分枝杆菌复合群(Mtb)感染1561例(初治921例,复治640例),筛选出481例耐药肺结核病例,结合病例进行耐药性分析。结果 1561例Mtb感染者中总耐药率为30.81%,耐药病人中,以中青年人为主;单耐药(SDR)中,耐链霉素病例最多,没有发现单耐卡那霉素的菌株;多耐药(PDR)和耐多药(MDR)中S+H、S+H+R耐药病例占大多数;总耐多药率为8.07%(126/1561),复治广泛耐药(XDR)率为1.55%(10/640)。结论武汉市结核耐药病人年青化;武汉地区单耐药中,链霉素耐药率最高;S+H、S+H+R耐药病例大量出现应引起临床的重视;结核耐多药病例得到了一定的遏制,但XDR病例不容乐观。

Analysis of drug resistance of 1561 tuberculosis patients in Wuhan

Objective To investigate the current situation and the development trend in drug-resistant tuberculosis patients in Wuhan in 2012. Methods The positive sputum specimens of tuberculosis culture were given drug sensitivity test by using rifampicin （R）, isoniazid （H）, streptomycin （S）, ethambutol （E）, ofloxacin （O）, and kanamyein （K）. Through the identification, 1561 patients （921 newly diagnosed cases and 640 retreated cases ） were confirmed with Mtb infection, and 481 cases of TB-resistant were screened. Results The total drug resistance rate was 30.81%, young patients mainly. In single drug resistance （ SDR）, most cases were streptomycin- resistant, without kanamycin-resistant. In poly drug-resistant （PDR） and muhidrug-resistant （MDR） cases, S ＋ H, S ＋ H ＋ R resistant cases accounted for the majority. The total MDR rate was 8.07% （ 126/1561 ）, the retreated extensively drug-resistant （XDR） rate was 1.55% （10/640）. Conclusion Most TB drug resistance patients are young in Wuhan. The rate of streptomycin-resistant is the highest. The S ＋ H, S ＋ H ＋ R resistant cases should be paid more attention.