2013—2018年河南省5个耐药监测点结核分枝杆菌耐药性

目的 了解河南省5个耐药监测点结核分枝杆菌的耐药情况，为制定结核病疫情控制策略提供参考。 方法 收集2013—2018年河南省5个耐药监测点1 716例结核病患者临床分离株及临床信息，采用比例法测定9种常用抗结核药物敏感性，并分析其耐药特征变化。 结果 结核病患者的总耐药率为24.07%(413/1 716)，耐多药率为3.73%(64/1 716)。一线抗结核药物耐药率由高到低依次为：链霉素(SM)13.34%(229株)、异烟肼(INH)10.08%(173株)、利福平(RIF)5.19%(89株)、乙胺丁醇(EMB)4.49%(77株)；二线抗结核药物耐药率由高到低为：氧氟沙星(OFX)3.15%(54株)、卡那霉素(KAM)2.51%(43株)和卷曲霉素(CPM)2.51%(43株)、对氨基水杨酸(PAS)1.98%(34株)、丙硫异烟胺(PTO)1.46%(25株)。耐药谱结果显示，413株菌分布在68种不同耐药类型中，单耐药中SM、多耐药INH+SM组合、耐多药组合中INH+RIF和INH+RIF+SM组合的耐药率较高。初治患者耐药率和耐多药率分别为20.13%(216/1 073)、2.80%(30/1 073)，复治患者耐药率和耐多药率分别为30.64%(197/643)、5.29%(34/643)，复治患者耐药率和耐多药率均高于初治患者(均P＜0.05)。41~60岁年龄组患者耐药率最高(29.25%)，2~20岁年龄组患者耐药率最低(13.56%)，各年龄组耐药率比较，差异有统计学意义(P < 0.05)。耐药趋势分析结果显示，2013—2018年仅耐多药率呈逐年升高趋势(P＜0.05)。 结论 河南省5个耐药监测点结核分枝杆菌耐药情况仍然较为严重，耐药谱结果显示耐药类型表现多样化和复杂化，41~60岁年龄组患者耐药率较高，复治患者耐药率较高，耐多药呈上升趋势。因此需要规范治疗，同时开展耐药筛查，减少耐药患者产生，加强耐多药患者的治疗和管理，防止传播。

Drug resistance of Mycobacterium tuberculosis in five monitoring sites of Henan Province, 2013-2018

Objective To understand the drug resistance of Mycobacterium tuberculosis (M. tuberculosis) in five drug resistance monitoring sites in Henan Province, and provide reference for formulating the control strategies of tuberculosis epidemic. Methods The strains and clinical information of 1 716 tuberculosis patients were collected from five drug resistance monitoring sites in Henan Province in 2013-2018. M. tuberculosis was tested for the sensitivity to nine anti-tuberculosis drugs by proportional method, changes in their drug resistance was analyzed. Results The total drug resistance rate and multidrug resistance (MDR) rate of tuberculosis patients were 24.07% (413/1 716) and 3.73% (64/1 716) respectively. Drug resistance rates of the first-line anti-tuberculosis drugs from high to low were as follows: streptomycin (SM) 13.34% (n=229), isoniazid (INH) 10.08% (n=173), rifampicin (RIF) 5.19% (n=89), and ethambutol (EMB) 4.49% (n=77). Drug resistance rates of the second-line anti-tuberculosis drugs from high to low were as follows: ofloxacin (OFX) 3.15% (n=54), kanamycin (KAM) 2.51% (n=43), capreomycin (CPM) 2.51% (n=43), p-aminosalicylic acid (PAS) 1.98% (n=34), and prothionamide (PTO) 1.46% (n=25). Drug resistance profile showed that 413 strains were distributed among 68 different drug resistance types, mono-drug resistance rate of SM, poly-drug resistance of INH+SM, as well as MDR rates of INH+RIF and INH+RIF+SM were higher. The drug resistance rates and MDR rates of initial treated patients were 20.13% (216/1 073) and 2.80% (30/1 073), respectively. Drug resistance rates and MDR rates of retreated patients were 30.64% (197/643) and 5.29% (34/643), respectively. Drug resistance rates and MDR rates of retreated patients were both higher than those of initial treated patients (both P < 0.05). Patients aged 41 to 60 years had the highest drug resistance rate of 29.25%, and patients aged 2 to 20 years had the lowest drug resistance rate of 13.56%. There was statistically significant difference in drug resistance rates among different age groups (P < 0.05). Drug resistance trend analysis showed that only the MDR rate increased year by year in 2013-2018 (P < 0.05). Conclusion Drug resistance of Mycobacterium tuberculosis in five drug resistance monitoring sites in Henan Province is still serious, drug resistance profile showed that the types of drug resistance were diverse and complicated, drug resistance rates of patients aged 41-60 years and retreated patients are high, and MDR rate showed a rising trend. Therefore, it is necessary to standardize treatment, carry out screening on drug resistance, reduce the occurrence of drug-resistant patients, strengthen the treatment and management of MDR patients to prevent transmission.