重庆市复治涂阳肺结核患者耐药分析

目的 通过了解重庆市复治涂阳肺结核患者对抗结核药物的耐药情况，为改进重庆市肺结核病的防治措施提供参考和建议。方法 收集重庆市39个区县2016年5月至2017年10月期间复治涂阳患者培养阳性的菌株，并采用对硝基苯甲酸培养法鉴定结核分枝杆菌复合群。共收集428例复治涂阳肺结核患者菌株，采用传统的比例法进行8种抗结核药物的药敏试验，并对复治涂阳肺结核患者菌株耐（多）药情况进行分析。8种抗结核药物包括：异烟肼（INH）、利福平（RFP）、链霉素（Sm）、乙胺丁醇（EMB）、氧氟沙星（Ofx）、卡那霉素（Km），阿米卡星（Am）和卷曲霉素（Cm）。结果 纳入的428例复治肺结核患者总耐药率为45.09%，以青年组耐药率最高，达57.14%，显著高于老年组（36.59%，P=0.002<0.017)，但与中年组比较差异无统计学意义（43.52% P=0.022(>)0.017）；复治肺结核患者耐多药率为27.10%，其中青年组耐多药率（41.96%）显著高于中年组（24.35%）和老年组（17.89%, P<0.05)；复治肺结核患者广泛耐药率达3.74%，耐Ofx及耐任一种二线注射类抗结核药物（包括Km、Am和Cm）的比例分别为16.12%和6.31%；复治肺结核患者对4种一线抗结核药物的耐药率顺位为：利福平（33.18%）、异烟肼（32.94%）、链霉素（28.74%）、乙胺丁醇（9.11%）。复治涂阳肺结核患者耐一种抗结核药物的耐药率为10.28%，对8种抗结核药物全部耐药的比例为1.17%。复治涂阳肺结核患者耐药状况不同性别之间差异无统计学意义。结论 重庆市复治涂阳肺结核患者的耐药形势严峻，其中青年是耐多药结核病发生的危险人群，应根据本市情况制定科学合理的结核病防治方案，减少耐药结核病的产生和传播。

Drug-resistant conditions of re-treatment smear positive tuberculosis patients in Chongqing

Objective To understand the current status of drug resistance of re-treatment smear positive tuberculosis (TB) patients in Chongqing City, so as to provide advice for improving the prevention and treatment of pulmonary tuberculosis (PTB). Methods The culture positive strains from re-treatment smear positive TB patients in 39 districts of Chongqing City from May 2016 to October 2017 were collected, and the identification of Mycobacterium tuberculosis complex was identified based on the para-nitrobenzoic acid culture test. Finally 428 strains from re-treatment smear positive PTB patients were collected, and drug susceptibility testing was performed for eight kinds of anti-tuberculosis drugs. The drug resistant status of these strains was analyzed. The eight kinds of anti-tuberculosis drugs including: isoniazid (INH), rifampicin (RFP), streptomycin (Sm), ethambutol (EMB), ofloxacin (Ofx), kanamycin (Km), amikacin (Am) and capreomycin (Cm). Results The drug resistant rate of the 428 re-treatment smear positive PTB patients was 45.09%, and the drug resistant rate in the young group (57.14%) was significant higher than that in the old group (36.59%, P=0.002＜0.017), but there was no significant difference compared with that in the middle age group (43.52%，P=0.022＞0.017); the multi-drug resistant rate of re-treatment smear positive PTB patients was 27.10%, and the rate in the young group (41.96%) was significantly higher than that in the middle age group (24.35%) and old group (17.89%, both P＜0.05); the extensive drug resistant rate of re-treatment smear positive PTB patients was 3.74%, the Ofx-resistant rate and any second-line injection drug (including Km, Am and Cm) resistant rate were 16.12% and 6.31%, respectively. The sequence of the drug resistant rates was as follows: RFP (33.18%), INH (32.94%), Sm (28.74%) and EMB (9.11%). The drug resistant rate of re-treatment smear positive PTB patients for one drug was 10.28%, and for all the eight kinds of drugs was 1.17%. The drug resistant rate of re-treatment smear positive PTB patients had no significant difference between different sexes. Conclusion The drug resistant situation of re-treatment smear positive TB patients in Chongqing City is severe, and therefore, the treatment and management of re-treatment TB patients should be strengthened to effectively reduce the generation and transmission of drug resistant TB.