西安市111例耐多药肺结核患者的药物敏感试验结果

目的 分析西安市目前耐多药结核病（MDR-TB）患者的耐药状况，为合理选用耐多药抗结核方案提供依据。方法 收集西安市2016年1月—2016年12月经痰检分离并鉴定为MDR的结核分枝杆菌药物敏感试验资料，并对其一线及二线抗结核药物进行药敏检测，使用卡方检验对初始耐多药与获得性耐多药组间进行比较。结果 111株MDR的结核分枝杆菌对链霉素和乙胺丁醇的耐药率分别为85.6%和45.0%，二线抗结核药物耐药率由高至低分别为左氧氟沙星（42.3%）、莫西沙星（34.2%）、对氨基水杨酸钠（9.9%）、阿米卡星（8.1%）、丙硫异烟胺（7.2%）、卷曲霉素（4.5%）。链霉素、乙胺丁醇、阿米卡星、卷曲霉素、丙硫异烟胺和对氨基水杨酸钠在初始耐药和获得性耐药两组患者中的耐药率无显著性差异。左氧氟沙星和莫西沙星在获得性耐多药患者中的耐药比例均显著高于初始耐多药组（P<0.05）。结论 西安市MDR-TB临床分离株对链霉素和乙胺丁醇的耐药现象较为严重，对阿米卡星和卷曲霉素敏感性好，而对氟喹诺酮类药物耐药情况严重，在耐多药结核病治疗中应考虑到初始耐药和获得性耐药的不同，制定合理的化疗方案，并强化针对耐多药结核病的控制策略（DOTS-plus策略），特别是要合理使用氟喹诺酮类药物。

Drug sensitivity test among patients with multidrug-resistant tuberculosis in Xi'an: a report of 111 cases of drug-resistant strains

Objective To analyses the drug resistant rate and spectrum in multidrug-resistant tuberculosis (MDR-TB) patients in Xi’an City, and to provide basis for the rational regimen selection of MDR-TB. Methods A total of 111 Mycobacterium tuberculosis strains of multidrug-resistant, which were collected and identified from the sputum samples of the patients in Xi’an from January 2016 to December 2016, were evaluated for drug sensitivity test with the first-line and second-line anti-tuberculosis drugs， retrospectively. Chi square test was used to compare the initial multidrug-resistant and acquired multi drug resistant between the groups with SPSS18.0 software. Results The drug-resistant rate of streptomycin and ethambutol were 85.6% and 45.0% respectively in all 111 strains. The second-line anti-tuberculosis drugs with drug resistance rates in descending order in 111 clinical isolates were as follows: levofloxacin (42.3%), moxifloxacin (34.2%), sodium 4-aminosalicylate dihydrate (9.9%), amikacin (8.1%), protionamide (7.2%), capreomycin (4.5%). There were no significant differences in the drug-resistant rate of streptomycin, ethambutol, amikacin, capreomycin, prothioisoamide, sodium 4-aminosalicylate dehydrate between the patients of initial multidrug-resistant and acquired multi drug resistant. The drug-resistant rate of levofloxacin and moxifloxacin in acquired drug resistance MDR-TB patients were significant higher than that in initial drug resistance MDR-TB patients (P<0.05). Conclusion The resistance of MDR-TB to first-line and second-line anti-tuberculosis drugs is serious in Xi’an City. The resistant rate of the clinical isolates to streptomycin and ethambutol is serious and the resistant rate to amikacin and capreomycin is at a low level. The resistant rate to fluoroquinolones is very serious. The treatment for MDR-TB patients should considerate the difference between initial drug resistance and acquired drug resistance tuberculosis, especially the drug-resistant rate of fluoroquinolones. Formulating reasonable chemotherapy regimens and strengthening the DOTS-plus strategy, especially with the rational use of fluoroquinolones are very important.