湖北省不同年龄组和用药时间结核分枝杆菌耐药性的研究

目的 :了解湖北省不同年龄组和用药时间结核分枝杆菌耐药情况 ,探讨其发展趋势。方法 :根据年龄将10 90例肺结核患者分为 15～ ,2 5～ ,35～ ,4 5～ ,5 5～和≥ 6 5岁 6组 ;采用比例法进行抗结核药物耐药性测定。结果 :6组的初始和获得性耐药率分别为 13.9% ,16 .4 % ,10 .4 % ,13.4 % ,30 .1% ,35 .7%和 30 .4 % ,4 5 .8% ,4 1.0 % ,5 5 .6 % ,4 8.8% ,36 .8%。各年龄组初始和获得性耐药频度从高到低依次分别为S、H、R、E和H、R、S、E。其中初始耐多药最高的组为≥ 6 5岁组 (35 .7% ) ,获得性耐多药最高的组为 15～ 2 4岁组 (30 .4 % )。既往未用药者耐药率为 16 .7% ,与用药不足 1月和 1～ 3月者耐药率无显著性差异 (P >0 .0 5 ) ,但与用药时间大于 3月者均有显著性差异。此外 ,不规则用药时间越长 ,耐药发生率越高 ;在各年龄组中中青年病人 (2 5～ 5 4岁 )耐药发生率较高。结论 :不同年龄组无论初始和获得性耐药率均有所不同 ,且耐药率随着用药史的延长而增高 ,建议应加强重视对中青年初始结核病人的治疗 ,避免该组病人高耐药率的产生。

Study on Drug Resitance of Mycobacterium Tuberculosis in Different Age Group and Time of Anti-tuberculosis Medications in Hubei Province

Objective: To investigate drug resistance of mycobacterium tuberculosis in different age groups and time of anti-tuberculosis medications in Hubei province,and to analyze its trend. Methods:1 090 cases of pulmonary tuberculosis with culture positive were divided into 6 groups according to age: 15～,25～,35～,45～,55～ and ≥65 years old. Identification and susceptibility (proportion method for SM,INH,RFP and EMB) tests were done in all cases. All data were analyzed by WHO provided SDR-TB2 software,and relative statical test used Epi6 software. Results:The rates of initial drug resistance in six groups were13.9%,16.4%,10.4%, 13.4%,30.1% and 35.7% respectively,and the rates of acquired drug resistance were 30.4%, 45.8%,41.0%,55.6%,48.8% and 36.8 % respectively. From higher to lower,the frequencies of initial and acquired drug resistance in different age groups were SM,INH,RFP, EMB,respectively and INH,RFP,SM,EMB,respectively. The rate of initial multi-drug resistance in ≥65 group was the highest in all groups(35.7%),and the rate of acquired multi-drug resistance in 15～24 group was higher than any other groups. The drug resistance rate in the group never-using drug was 16.7%. It was significant lower than the others who had used drug(s). Moreover,the longer using drugs,the higher drug resistance rate,and the rate in the group of 25～54 years was the highest in all groups. Conclusion:Initial and acquired drug resistance rate varies in different age groups,and the rate is increasing as time of using drugs goes on. It is suggested that the treatment for initial cases in middle age group (25～54) should be seriously taken,so as to avoid the high drug resistance rate later.