不同年龄组结核分支杆菌耐药性的研究

目的 了解近阶段不同年龄组结核分支杆菌耐药情况，探讨当前耐药发展趋势。方法 根据年龄将1948例肺结核患者分为青年组（18－39岁），中年组（40－59岁）和老年组（≥60岁）；采用绝对浓度法进行抗结核药物耐药性测定。结果 青年组、中年组、老年组原发耐药率分别为36．1％、46．8％和40．2％，各组间差异无显著性（P＞0．05）。青年组、中年组、老年组获得性而药率分另为81．3％、70．1％和62．1％，青年组和老年组差异有显著性（P＝0．0916）。原发耐药频度各年龄组从高到低均依次为H、E、S、P，中年组耐R最高达10．6％。获得性耐药顺序青、中年组为H、R、S、E，老年组为H、S、R、E，其中青年组耐R率最高达63．3％。原发耐多药率以中年组最高为5．3％，显著高于青年组（P＝0．0112）和老年组（P＝0．0085）。获得性耐多药率青年组最高达55．2％，显著高于中年组（P＝0．0319）和老年组（P＜0．001）。既往用1－3个月者耐药58．7％，显著高于未用药者（P＜0．001）和用药＜1月者（P＝0．0472），而未用药和有药＜1月者耐药率差异无显著性（P＝0．02929）。此外，在各年龄组中青年组发生耐药的速度最快。结论 不同年龄组无论原发耐药还是获得性耐药均有所不同，建议应重视不同年龄组耐药率的监测，为修订国家结核病规划提供依据。

Study on drug resistance of Mycobacterium tuberculosis in different age group

OBJECTIVE: To investigate drug resistance of Mycobacterium tuberculosis in different age group in recent five years, and to analyze the trends of drug resistance at present. METHODS: 1 948 cases of pulmonary tuberculosis with culture-positive were divided into youth group (18 approximately 39 years), middle age group (40 approximately 59 years) and old age group (>/=60 years). All of the strains of Mycobacterium tuberculosis were tested for resistance to INH, RFP, SM and EMB by the absolute concentration method. RESULTS: The rate of primary drug resistance in youth group was 36.1%, in middle age group 46.8%, in old age group 40.2%, there were no significant differences among them (P > 0.05). The rate of acquired drug resistance was higher in youth group than that in old age group (P = 0.019 6). The primary resistance rate to RFP in middle age group was 10.6%, much higher than that in youth group and in old age group. The acquired resistance rate to RFP in youth group was 63.6%, higher than that in middle age group and in old age group. The rate of primary multi-drug resistance in middle age group was 5.3%, higher than that in youth group (P = 0.011 2) and in old age group (P = 0.008 5). The rate of acquired multi-drug resistance in youth group was 55.2%, higher than that in middle age group (P = 0.031 9) and in old age group (P < 0.001). The drug resistance rate in using drugs 1 approximately 3 months group was 58.7%, higher than that in never using drug group (P < 0.001) and in using drugs < 1 month group (P = 0.047 2). The drug resistance rate had no significant difference between never using drug group and using drugs < 1 month group. The emergency of drug resistance in youth group was fastest in all age groups. CONCLUSIONS: Primary drug resistance or acquired drug resistance varies in different age group. It is suggested that the surveillance of drug resistance in different age group should be taken seriously, so as to provide an important basis for revising National Tuberculosis Programme (NTP).