惠州市最新肺结核耐药监测结果及趋势分析

目的分析惠州市最新肺结核耐药监测结果及趋势,为进一步完善本地区肺结核防控对策提供依据。方法 2013年1月—2014年5月,对惠州市各县区涂阳培阳患者进行抽样调查,本研究共监测6个试点,共纳入肺结核患者638例。对患者进行痰菌分离培养,采用比例法进行一线药及二线药耐药性检测。结果本次抽样菌株总耐药率为45.1%,其中初治总耐药率为33.1%、复治总耐药率为60.8%。初治涂阳患者单一耐药率〔12.9%(82/638)〕低于复合耐药率〔32.3%(206/638)〕,总耐多药率低于复治涂阳患者(P0.05)。初、复治涂阳患者异烟肼(INH,H)+利福平(RFP,R)耐药率均为最高。单一任意耐药顺序为:H(194)R(131)链霉素(SM,S)(131)氧氟沙星(OFX)(84)乙胺丁醇(EMB,E)(33)左氧氟沙星(LOF)(32)卡那霉素(KM)(31)对氨基水杨酸(PAS)(15)卷曲霉素(CM)(14)丁胺卡那(AM)(10)丙硫异烟胺(TH1321)(8)。结论惠州市肺结核耐药情况复杂多样,耐多药肺结核有上升趋势,面临耐多药、广泛耐药肺结核的挑战,应重点关注H、R、S这3种一线抗结核药物的合理使用,以减少耐药菌株的产生和传播,降低耐药肺结核发生率。

New Monitoring Results of Tuberculosis Drug Resistance and Its Trend in Huizhou

Objective To analyze the new monitoring results of tuberculosis drug resistance and its trends in Huizhou, to provide the basis for further prevention and control measures. Methods From January 2013 to May 2014,638 tuberculosis patients from 6 monitoring places were chosen by sample survey,they were diagnosed by positive smear culture. All patients had sputum isolated culture,and the resistance to first-line anti-tuberculosis drugs and second-line anti-tuberculosis drugs were detected by proportional method. Results The total drug resistant rate was 45. 1%, thereinto the initial resistant rate was 33. 1%,acquired drug resistant rate was 60. 8%. The single drug resistant rate of newly treated patients〔12. 9%（ 82/638）〕was lower than that of complex durgs resistant rate〔32. 3%（206/638）〕,total MDR rate was lower than that of retreat patients （P﹤0. 05）. The resistant rate of isoniazid（INH,H） ﹢ rifampicin（RFP,R）is highest in newly treated patients and retreat patients. The order of single drug resistant rate was：H（194） ﹥R（131） ﹥ streptomycin（SM,S）（131） ﹥ofloxacin （OFX）（84） ﹥ethambutol（EMB,E）（33） ﹥levofloxacin（LOF）（32） ﹥ kanamycin（KM）（31） ﹥4-amino sali-cylic acid（PAS）（15） ﹥capreomycin（CM） （14） ﹥amikacin（AM） （10） ﹥propylthiouracil isonicotinoyl amine （ TH1321）（8）. Conclusion Tuberculosis drug resistance in Huizhou is complex and various,and MDR rate is rising,brings the the challenge of MDR tuberculosis and extensively drug-resistant tuberculosis. We should focus on the usage of H,R,S of first-line anti-tuberculosis drugs,to reduce the drug resistant strains of tuberculosis and drug resistant tuberculosis.