2672例住院肺结核病人的耐药情况分析

目的了解住院肺结核病人的耐药情况。方法对安徽省胸科医院2011年11月-2013年5月痰结核菌培养阳性住院肺结核患者,采用改良罗氏培养基对结核杆菌进行培养和药敏实验,按《结核病诊断细菌学检验规程》要求,进行标本收集、处理及分离培养、菌种鉴定,并对异烟肼、利福平、乙胺丁醇、链霉素进行药敏实验。结果收治的2 672例肺结核病例,耐药率为25.5%,其中初治组为12.6%,复治组为58.8%;耐多药率初治组为4.1%,复治组为34.7%,以上差异均有统计学意义(P值均0.01)。耐1种、2种、3种、4种抗结核药物耐药率复治组均高于初治组(P值均0.01)。初治组中耐药率最高的为链霉素(8.6%),复治组中最高的为利福平(50.5%),不同抗结核药物两组耐药率差异均有统计学意义(P值均0.01)。复治耐药肺结核病人中,发生不规则用药、治疗中断的占79.5%。结论肺结核病人耐药情况严重,不规则用药和治疗中断是导致耐多药的主要原因。应加强督导和管理,防止耐药菌株的产生和传播。

Analysis of drug-resistance situation on 2 672 pulmonary tuberculosis inpatients

Objective To understand drug-resistance situation of pulmonary tuberculosis inpatients. Methods According to TB diagnostic bacteriology testing procedures, specimens of positive sputum culture TB inpatients were collected, treated and subjected to bacteria culture, isolation and identification in Anhui Provincial Chest Hospital from November 2011 to May 2013. New LJ media was used for culture of Mycobacterium tuberculosis. Susceptibility tests were performed against isoniazid, rif- ampicin, ethambutol and streptomycin. Results Overall drug-resistance rate was 25.5% for 2 672 TB inpatients. For initial treatment group and retreatment group, drug-resistance rate was 12.6 % and 58.8 V0, respectively, with significant difference （P〈0.01）. Multidrug-resistance rate for initial treatment group and retreatment group was 4.1% and 34. 7%, respectively, with significant difference （P〈0.01）. Rate of resistance to 1, 2, 3, 4 kinds of anti-TB drug for retreatment group was higher than that of initial treatment group （P〈0.01）. Streptomycin had the highest resistance rate（8.6 %） in initial treatment groups while rifampicin had the highest resistance rate in retreated group （50.5 %）. Different drugs against TB demonstrated signifi- cant difference for drug resistance rate in above 2 groups （P〈0.01）. Occurrence of irregular medication and treatment inter- ruption accounted for 79.5% of drug-resistance cases in retreatment group. Conclusion Drug-resistance was a serious problem among TB patients. Irregular medication and treatment interruption were major reasons. Supervision and management should be strengthened to prevent generation and spreading of drug-resistance strains.