2010-2012年浙江省常山县涂阳肺结核耐药监测结果分析

摘要:目的　分析2010-2012年常山县涂阳肺结核患者结核分枝杆菌的耐药情况与耐药谱。方法　对2010年1月-2012年12月在常山县人民医院（浙江省结核病定点医院）结核门诊诊断、治疗的涂阳肺结核病例的痰进行结核分枝杆菌培养，菌型鉴定为结核分枝杆菌的菌株采用比例法进行6种抗结核药物［异烟肼（H）、利福平（R）、乙胺丁醇（E）、链霉素（s）、左氧氟沙星（O）、卡那霉素（KM）］耐药性测试。结果　260株结核分枝杆菌病例中，总耐药率17.31％，初始耐药率和获得性耐药率分别为11.16％和55.56％，两者差异具有统计学意义（χ2＝45.75，P＜0.01）；耐药类型，单耐药率为8.85％，多耐药率为3.08％，耐多药率为4.62％，广泛耐药率为0.77％。耐药率最高为H 11.15%，S 9.23%；初治涂阳单耐药率顺位前2位是H（6.70%）和S（6.25%），而复治涂阳单耐药率顺位前2位是H（38.89%）和（36.11%）；多耐药谱，初治涂阳以H+S常见，复治涂阳以R+O，H+S+O常见；耐多药谱以H+R，H+R+S常见。结论　常山县总耐药率、耐多药率、初始耐药率分别低于全国第五次结核病流调的结果，获得性耐药率和耐多药率则高于全国第五次结核病流调的结果。

Smear-positive tuberculosis drug resistance monitoring result in Changshan, 2010-2012

Abstract: Objective To analyze mycobacterium tuberculosis drug resistance situation and drug-resistant spectrum of patients with smear-positive pulmonary tuberculosis in Changshan from 2010 to 2012. Methods From January 2010 to December 2012, a tuberculosis (TB) fixed-point hospital in Zhejiang province Changshan county people's hospital, clinic diagnosis and treatment of smear-positive pulmonary tuberculosis cases sputum mycobacterium tuberculosis culture, bacteria which were identified as mycobacterium tuberculosis strain ratio method was used for 6 kinds of anti-tb drugs [isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (s), levofloxacin (O), kanamycin (KM) ] drug resistance test. Results Among 260 strains of mycobacterium tuberculosis cases, 17.31% of thewere total resistance, and the initial resistance and acquired resistance were 11.16% and 55.56%, respectively. The difference is statistically significant (χ2=45.75, P<0.01); Resistant type, monoresistance rate of was 8.85%, polyPoly- resistance rate of was 3.08%, and multi-drug resistance rate was 4.62%. Extensively drug-resistant rate of was 0.77%. H is was the highest percentages of 11.15% and S was 9.23%; Initial smear-positive monoresistance sequence of the percentages of the former two were H (6.70%) and S (6.25%), and recurrent smear-positive monoresistance sequence of the percentages of the former two were H (38.89%) and (36.11%). Among the Multiple drug-resistant spectrum, initial smear-positive to H + S common, recurrent case with R + O, H + S + O common; Multi-drug resistant spectrum with H + R, H + R + S common. Conclusion The total resistance rate, multi-drug resistance rate and initial resistance rate of Changshan were lower than the results of the fifth national tuberculosis epidemiological survey, while the acquired resistance rate and the multi-drug resistance rate were higher than the results of the fifth national tuberculosis epidemiological survey.