浙江省衢州市分枝杆菌菌种鉴定和耐药现状研究

摘要：目的　了解衢州市分枝杆菌菌种分布和耐药情况，为结核病防治提供参考依据。方法　选取２０１４－２０１７年衢州市各结核病定点医院上送衢州市人民医院的２３８４株分枝杆菌菌株，采用ＰＮＢ／ＴＣＨ （Ｐ Ｎｉｔｒｏｂｅｎｚｏｉｃａｃｉｄ／ｔｈｉｏｐｈｅｎｅ ２ ｃａｒｂｏｘｙｌｉｃａｃｉｄ）生长试验进行菌种鉴定，对四种一线抗结核药物：异烟肼（ｉｓｏｎｉ ａｚｉｄ，ＩＮＨ）、利福平（ｒｉｆａｍｐｉｃｉｎ，ＲＦＰ）、乙胺丁醇（ｅｔｈａｍｂｕｔｏｌ，ＥＭＢ）、链霉素（ｓｔｒｅｐｔｏｍｙｃｉｎ，ＳＭ）进行耐药性监测。结果　２３８４株分枝杆菌经过鉴定，结核分枝杆菌２２７０株（９５．２２％），非结核分枝杆菌（ｎｏｎｔｕｂｅｒｃｕｌｏｓｉｓｍｙｃｏｂａｃｔｅｒｉａｌ，ＮＴＭ）１１４株（４．７８％）；２２７０ 株结核分枝杆菌总耐多药率为５．５１％ ；复治患者的总耐药率、耐多药率以及对ＩＮＨ 、ＲＦＰ、ＥＭＢ、ＳＭ 任一药物的耐药率均高于初治患者，差异有统计学意义（均犘＜０．０１）；单一耐药的前３位为ＳＭ＞ＩＮＨ＞ＲＦＰ；多耐药和耐多药的前３位为ＩＮＨ＋ＲＦＰ ＋ ＳＭ＞ＩＮＨ ＋ ＳＭ＞ＩＮＨ ＋ＲＦＰ。结论　衢州市的复治患者的耐药情况较为严重，需进一步改善结核病的预防控制工作。关键词：肺结核；分枝杆菌；ＰＮＢ／ＴＣＨ 生长试验；药敏；耐药率；耐多药中图分类号：Ｒ１８３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１９）０３ ０１９１ ０４

Analysis of death cause among 449 senior inpatients

Objective To analyze the cause of death among senior inpatients in Beijing,and to discuss the major risk factors threaten the life of the elderly. Methods A retrospective study was conducted among senior patients aged over 60years hospitalized between 2009to 2013in Beijing Frienship Hospital.Their clinical data were retrieved and analyzed in terms of general health condition,disease diagnosis and cause of death. Results Data of a total 2 910inpatients and 449dead cases were analyzed and the analysis showed that the most common cause of death was pulmonary infection（175cases,38.97%）,followed by malignant tumor（162cases, 36.08%）,cardiovascular disease（50cases,11.14%）,cerebrovascular disease（22cases,4.90%）,digestive system disease（19cases,4.23%）,urinary system disease（11cases,2.45%）and others（10cases, 2.23%）.The risks of death caused by pulmonary infection and malignant tumor increased gradually along with age. Conclusions Pulmonary infection and malignant tumor are major causes of death among senior inpatients.Therefore,specific health education focusing on the prevention of pulmonary infection as well as early screening and treatment for malignant tumors should be strengthened.Meanwhile,effective control of risk factors of cardiovascular and cerebrovascular diseases may significantly reduce the death rate.