杭州市1 731株结核分枝杆菌耐药状况分析

目的 了解杭州市区县范围内耐药结核病的流行状况。方法 采用浓度比例法和PNB/TCH生长实验对2018年1月至2019年12月分离自杭州市周边7个县区的1 975份肺结核病人的培养菌株进行药物敏感性实验和菌种鉴定,并用统计学方法分析耐药谱和耐药率。结果 1 731株结核分枝杆菌(Mycobacterium tuberculosis,MTB)中, 18.26%(316/1 731)菌株至少对一种受试药物耐药,一线药物、二线药物、单耐药、多耐药、耐多药、广泛耐药、利福平耐药的耐药率分别是14.96%(259/1 731)、4.97%(86/1 731)、11.84%(205/1 731)、3.81%(66/1 731)、2.60%(45/1 731)、0.06%(1/1 731)、3.24%(56/1 731),共28种耐药谱。初治患者耐药率与复治患者耐药率差异无统计学意义(P>0.05)。比较2011年、2015年、2018-2019年这3个时间段,一线药物的总耐药率、初治患者耐药率、复治患者耐药率以及耐多药的总耐药率和复治耐药率均呈现下降趋势(均P<0.05)。二线药物OFX的总耐药率和初治患者耐药率较2015年升高(P<0.05)。60岁以上的结核病患者占比最大(47.95%)。7个区县的耐药率存在差异。结论 2011-2019年杭州市区县结核病定点医院收治的结核病人的耐药率逐年下降,目前采取的防控措施切实有效。今后要重点关注耐药率较高区县的耐药病人和40~60岁耐药病人的治疗和管控,加强老年人结核病的防控。

Drug resistance of 1 731 Mycobacterium tuberculosis strains in Hangzhou

The objective of this study was to investigate the prevalence of drug-resistant tuberculosis in Hangzhou county. Drug sensitivity testing and species identification were performed on 1975 cultured strains isolated from patients diagnosed with pulmonary tuberculosis in seven suburban counties of Hangzhou from January 2018 to December 2019, with the concentration proportional method and PNB/TCH growth experiments, respectively. The drug resistance spectrum and drug resistance rate were statistically analyzed. Among 1 731 Mycobacterium tuberculosis (M. tuberculosis) strains, 18.26% (316/1 731) were resistant to at least one tested drug. The drug resistance rates of first line drugs, second line drugs, single drugs, multi-drug resistance, MDR-TB, XDR-TB and rifampicin resistance were 14.96% (259/1 731), 4.97% (86/1 731), 11.84% (205/1 731), 3.81% (66/1 731), 2.60% (45/1 731), 0.06% (1/1 731) and 3.24% (56/1 731), respectively. A total of 28 drug resistance spectra were found among the 1 731 strains. No significant difference was observed in drug resistance rates between untreated and retreated patients. The total drug resistance rate and the drug resistance rates in untreated and retreated patients receiving first-line drugs, and the total drug resistance rate and the drug resistance rate in untreated patients with MDR-TO be, all decreased significantly in the periods of 2011, 2015 and 2018-2019. The total drug resistance rate and untreated patient drug resistance rate for the second-line drug ofloxacin showed a prominent increase after 2015. The proportions of patients with TB older than 60 years and the drug resistance rate of patients with TB 40-60 years of age were highest. The drug resistance rates differed among the seven suburban counties. In conclusion, from 2011 to 2019, the drug resistance rate of patients with TB at designated tuberculosis hospitals in suburban counties of Hangzhou decreased each year; thus, current tuberculosis prevention and control measures are effective. In the future, close attention should be paid to treatment and control in drug-resistant patients in counties with high drug resistance rates and drug-resistant patients 40-60 years of age; moreover, prevention and control of tuberculosis in older populations should be strengthened.