浙江省温州地区196株分枝杆菌耐药监测情况

目的 了解浙江省温州市分枝杆菌耐药状况，为制定耐药结核病控制策略提供依据。方法 随机抽取温州市3县（市）作为耐药监测点，选取监测点2008年和2013年新发和复治涂阳肺结核患者分枝杆菌分离株196株进行4种一线抗结核药物异烟肼（H）、利福平（R）、链霉素（S）、乙胺丁醇（E）]的耐药性测定；对耐多药（MDR）菌株进行9种二线抗结核药物卡那霉素（KM）、阿米卡星（AM）、卷曲霉素（CPM）、对氨基水杨酸（PAS）、丙硫异烟胺（PTO）、环丝安酸（CS）、氧氟沙星（OfX）、左氧氟沙星（LVFX）、莫西沙星（MOX）]的耐药性测定。结果 在196株分枝杆菌中，结核分枝杆菌191株。总耐药率为25.1%（48/191），其中新涂阳和复治涂阳耐药率分别为21.9%（36/164）和44.4%（12/27），差异有统计学意义（2=6.23，P0.05）；MDR率为6.8%（13/191），其中新涂阳和复治涂阳MDR率分别为4.3%（7/164）和22.2%（6/27），差异有统计学意义（2=9.12，P0.01）；4种一线抗结核药物的耐药率由高到低依次为S（19.9%）、H（14.7%）、R（7.9%）、E（3.1%）；耐1、2、3和4种药物的耐药率分别为14.7%、5.2%、2.6%和2.6%；男性与女性的耐药率和MDR率分别为25.5%（36/141）、6.4%（9/141）和24.0%（12/50）、8.0%（4/50），差异无统计学意义（2分别为0.05和0.93，均P0.05）；不同年龄组间耐药率差异无统计学意义（2=5.34，P0.05）；MDR菌株二线抗结核药物耐药率达8/13；二线抗结核药物的耐药率由高到低依次为OFX和PAS（均为5/13）、CS（4/13）、LVFX和MOX（均为1/4）、CPM（1/13）。结论 温州市耐多药结核病疫情较严重，而且对二线抗结核药物具有较高的耐药率，建议开展二线抗结核药物敏感性检测，加强耐药结核病患者的发现和治疗管理工作。

Survey of drug resistance of 196 Mycobacterium isolates in Wenzhou,Zhejiang

Objective To understand the prevalence of drug-resistant Mycobacterium(M.) tuberculosis in Wenzhou, Zhejiang province, and provide evidence for the prevention and control of drug-resistant tuberculosis (TB). Methods The susceptibility tests of 196 M. tuberculosis strains isolated from smear positive TB patients to four first line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) and nine second-line anti-TB drugs (kanamycin, amikacin, capreomycin, p-aminosalicylic acid, protionamide, cyclocerine, ofloxacin, levofloxacin, moxifloxacin) were performed. Results A total of 191 M. tuberculosis strains were cultured. The overall drug-resistant rate was 25.1% (48/191); the initial drug-resistant rate was 21.9% (36/164) and the acquired drug-resistant rate was 44.4% (12/27), the difference was significant (2=6.23,P0.05).The multidrugresistant (MDR) rate was 6.8% (13/191), in which the initial and the acquired MDR rates were 4.3%(7/164) and 22.2% (6/27), respectively, the difference was significant (2=9.12,P0.01). The resistant rates to streptomycin, isoniazid, rifampicin and ethambutol were 19.9%, 14.7%, 7.9% and 3.1%, respectively. The resistant rates to one, two, three and four first line anti TB drugs were 14.7%, 5.2%, 2.6% and 2.6%, respectively. The overall drugresistant rate and MDR rate were 25.5%(36/141) and 6.4%(9/141), respectively, in males and 24.0% (12/50) and 8.0% (4/50) in females,the differences were not significant (2=0.05,2=0.93,allP0.05). The age specific overall drug resistant rate showed no significant differences (2=5.34,P0.05). In 13 MDR strains, 8 (61.5%) showed resistance to at least one secondline anti-TB drugs tested. For second line anti-TB drugs, the resistant rate to ofloxacin and p-aminosalicylic acid was highest(5/13), followed by that to cyclocerine (4/13), that to levofloxacin, moxifloxacin (1/4) and that to capreomycin (1/13). Conclusion The prevalence of MDR-TB was high in Wenzhou, it is necessary to strengthen the prevention and control of drugresistant TB by conducting the susceptibility test to the second line anti-TB drugs and improving the detection and treatment of drug resistant TB patients