武汉市涂阳肺结核患者耐药率及耐药谱分析

目的 分析不同登记分类涂阳肺结核患者的耐药［特别是耐多药结核病（MDR-TB）］特点，了解耐药的危险因素，为制订耐药结核病（特别是MDR-TB）控制策略提供参考。 方法 对痰涂片阳性的新患者、复治（复发、返回和其他）和治疗失败（初治失败、复治失败和治疗3个月末痰涂片阳性的新患者）3类患者收集2份痰标本进行培养，用比例法进行6种抗结核药物（INH、RFP、EMB、S、Km和Ofx）敏感性试验。2006年12月至2012年3月进行痰培养的涂阳肺结核患者2110例，培养阳性1947例（92.3%）；经药物敏感性试验和菌型鉴定，Mtb感染1800例（92.4%）。 结果 1800例Mtb感染者中总耐药794例（44.1%，794/1800），其中单耐药结核病（SDR-TB） 244例（13.6%, 244/1800）、多耐药结核病（PDR-TB）155例（8.6%,155/1800）、MDR-TB 395例（21.9%,395/1800）；MDR-TB检出率明显高于SDR-TB和PDR-TB（χ²=43.4，χ²=123.6，P值均＜0.01）。新患者、复治及治疗失败3类患者SDR-TB检出率分别为11.9%（57/480）、14.4%（159/1107）及13.1%（28/213），差异无统计学意义（χ²=0.33，P=0.85）；3类患者PDR-TB检出率分别为5.4%（26/480）、9.8%（109/1107）及9.4%（20/213）,复治与治疗失败PDR-TB检出率差异无统计学意义（χ²=0.04，P=0.84），但高于新患者（χ²=8.53，P=0.01）；3类患者MDR-TB检出率分别为14.4%（69/480）、22.5%（249/1107）及36.2%（77/213），经χ²检验，治疗失败患者MDR-TB检出率高于复治和新患者（χ²=17.92，χ²=42.07，P值均＜0.01）。 结论 武汉市涂阳肺结核患者耐药检出率高；耐药成因复杂，耐药谱呈多样性和复杂性，对结核病控制构成威胁。

Analysis of the drug resistance patterns and resistance rates among smear positive TB patients in Wuhan city

Objective To analyze the resistance characteristics of different registration classification smear positive TB patients（especially MDR-TB） and to understand the risk factors in order to provide reliable references for development of drug-resistant TB control strategy.Methods Two sputum samples were collected from each smear positive patient in 3 categories-new,re-treatment（relapse,transfer in and others） and treatment failure（failure of new patient,retreatment patient and new patients who remain smear positive after 3 months of treatment） for sputum culture by proportional method,six kinds of anti-TB drugs（INH,RFP,EMB,S,Km,Ofx） were tested for susceptibility.Between December 2006 and March 2012,a total of 2110 cases of smear positive TB patients were sputum cultured,in which 1947 cases（92.3%） were culture positive;through drug susceptibility test（DST） and bacterial typing,1800 cases of Mtb（92.4%） were identified eventually.Results Among the 1800 Mtb cases,a total of 794 cases（44.1%,794/1800） were identified as drug-resistant TB,out of which,244 cases（13.6%,244/1800） were single-drug-resistant（SDR） TB,155 cases（8.6%,155/1800） were poly-drug-resistant（PDR） TB,395 cases（21.9%,395/1800） were MDR-TB,the detection rate of MDR-TB is significantly higher than SDR-TB and PDR-TB（χ2=43.4,χ2=123.6,P0.01）.The detection rate of SDR for new,re-treatment and treatment failure TB patients was 11.9%（57/480）,14.4%（159/1107）and 13.1%（28/213）respectively,the diffe-rence is not statistically significant（χ2=0.33,P=0.85）;the detection rate of PDR for new,re-treatment and treatment failure TB patients was 5.4%（26/480）,9.8%（109/1107） and 9.4%（20/213） respectively,the difference is not statistically significant between retreatment and treatment failure cases（χ2=0.04,P=0.84）.however,they are higher than that of new TB cases（χ2=8.53,P=0.01）;the detection rate of MDR for new,re-treatment and treatment failure TB patients was 14.4%（69/480）,22.5%（249/1107） and 36.2%（77/213）respectively,the detection rate of treatment failure TB patients is higher than that of new and re-treatment TB patients（χ2=17.92,χ2=42.07,P0.01）.Conclusion The detection rate of drug resistant TB is high among smear positive TB patients in Wuhan.The diversity and complexity of drug resistant spectrum poses a threat to TB control in China.