江苏省海门市耐药肺结核病流行现状分析

目的 了解江苏省海门市耐药肺结核病流行现状、流行特点与危险因素,探索耐药肺结核病的防治方法. 方法 自2009年10月至2013年9月,对到海门市结核病防治机构就诊的全部336例痰涂片阳性肺结核患者的痰标本进行痰培养检查,所有涂阳患者连续纳入,不得跳选.对培养阳性的菌株进行菌型鉴定.对结核分枝杆菌菌株进行4种一线抗结核药物异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)敏感试验检查.计数资料的比较采用2分析,检验水准=0.05. 结果 4年共培养成功获得阳性菌株317株,其中结核分枝杆菌310株.在310株结核分枝杆菌分离株中,总耐药率24.5%(76/310),单耐药率9.7%(30/310),多耐药率2.9%(9/310),耐多药率11.9%(37/310).复治涂阳患者总耐药率和耐多药率均高于初治涂阳患者(2=55.294,P0.005, 2=71.471,P0.005).涂阳患者菌株单耐药谱中分离菌株对SM和INH单一耐药的比例较高,分别达46.7%和36.7%.多耐药谱中分离菌株对INH+SM耐药比例较高,占88.9%.耐多药谱中分离菌株以耐INH+RFP和耐INH+RFP+SM组合所占比例较高,分别达46.0%和29.7%. 结论 海门市耐多药肺结核病的流行较为严重,应加强耐多药肺结核病的发现和治疗管理工作.复治肺结核患者发生耐药的危险性较初治患者更高,应加强正规治疗等结核病防治知识的宣传、培训,重视对初治肺结核患者的治疗管理.

Prevalence of drug resistant tuberculosis in Haimen,Jiangsu

Objective To understand the prevalence of drug resistant tuberculosis (TB) and related rosk factors in Haimen, Jiangsu province, and provide evidence for the prevention and treatment of drug resistant TB. Methods Sputum culture was conducted for all the 336 smear positive TB patients seeking medical care in Haimen TB prevention and treatment institution from October 2009 to September 2013. Pathogen identification was conducted, and drug susceptibilities of Mycobacterium tuberculosis to 4 first line anti TB drugs isoniazid, rifampicin, ethambutal and streptomycin were tested. Results A total of 310 M. tuberculosis strains were cultured during this period. The overall drug resistant rate was 24.5% among the isolated M. tuberculosis strains (76/310). The single drug resistant rate was 9.7% (30/310). The multi drug resistant rate was 2.9% (9/310), the extensive drug resistant rate was 11.9% (37/310). The overall drug resistant rate in re-treated smear positive patients was higher than that in initial treated smear positive patients (2=55.294,P0.005, 2=71.471,P0.005). Among the strains from smear positive patients, the resistant rates to isoniazid and streptomycin were high (46.7% and 36.7%), the resistant rate to isoniazid+ streptomycin was 88.9% and the resistant rates to isoniazid + rifampicin and isoniazid + rifampicin + streptomycin were high 46.0% and 29.7%, respectively. Conclusion The prevalence of extensive drug resistant TB is high in Haimen, it is necessary to strengthen the case finding and treatment of extensive drug resistant TB. Re-treated TB patients are at higher risk to develop drug resistance, it is important to conduct standard treatment.