惠州市肺结核患者耐药谱分析

目的分析惠州市肺结核患者耐药谱,了解其耐药程度及耐药趋势。方法选择本所结核科2009年1月—2014年5月收治的肺结核患者1 810例,其中初治者1 020例(初治组),复治者790例(复治组)。对所有患者的菌株进行11种体外药敏试验,包括:异烟肼(INH,H)、链霉素(SM,S)、利福平(RFP,R)、乙胺丁醇(EMB,E)、卡那霉素(KM)、丁胺卡那(AM)、卷曲霉素(CM)、左氧氟沙星(LOF)、氧氟沙星(OFX)、对氨基水杨酸(PAS)、丙硫异烟胺(TH1321),并分析患者耐药谱。结果 1 810例肺结核患者分离菌株对一线抗结核药物耐药率为50.8%(920/1 020),对二线抗结核药物耐药率为20.3%(367/1 020)。初治组患者耐多药率〔7.2%(73/1 020)〕和7种二线抗结核药物耐药率〔20.2%(206/1 020)〕均低于复治组〔31.1%(246/790)、20.4%(161/790)〕(P0.05)。耐多药肺结核患者的耐药菌株对S、E的初始耐药率和获得耐药率较高,复敏率较低;对AM、CM、PAS、TH1321的初始耐药率和获得耐药率较低、复敏率较高;KM、LOF、OFX有较高的复治耐药率。结论惠州市肺结核患者对一线抗结核药物耐药率较高,需进一步加强对耐药肺结核的防控。复治肺结核患者耐药率仍处于较高水平,对耐药肺结核的临床治疗和管理应给以足够的重视。建议耐多药治疗方案中推广使用AM、CM、PAS、TH1321。实时监测耐多药肺结核患者的耐药谱,获取更新更全面的药敏资料,有助于合理制定个体化治疗方案,减少广泛耐药肺结核的产生。

Drug Resistance of Tuberculosis Patients in Huizhou

Objective To analyze the drug resistance of tuberculosis patients in Huizhou,to realize its level and trend. Methods From January 2009 to May 2014,1 018 tuberculosis patients were chosen in Department of Tuberculosis in our institute,including 1 020 newly treated patients（ newly treated group）,790 retreated patients（ retreated group）. Strains of all patients were collected and then given 11 kinds of drugs for sensitivity test in vitro,including isoniazid（ INH,H）,streptomy-cin（ SM, S ）, rifampicin （ RFP, R ）, ethambutol （ EMB, E ）, kanamycin （ KM ）, amikacin （ AM ）, capreomycin （CM）,levofloxacin（ LOF）,ofloxacin（ OFX）,4 - amino salicylic acid（ PAS）,propylthiouracil isonicotinoyl amine （TH1321）,and drug resistance were analyzed. Results In the 1 810 tuberculosis patients,the resistant rate of the first-line anti-tuberculosis drugs was 50. 8%（920/1 020）,the resistant rate of the second-line anti-tuberculosis drugs was 20. 3%（367/1 020）. The MDR rate〔7. 2%（73/1 020）〕and resistant rates of 7 kinds of second -line anti -tuberculosis drugs〔20. 2%（206/1 020）〕of newly treated group were lower than those of retreatment group〔31. 1%（246/790）,20. 4%（161/790）〕（P﹤0. 05）. Tuberculosis patients with MDR had higher initial resistant rates and acquired resistant rates of S, E,and lower re-sensitive rates;lower initial resistant rates and acquired resistant rates of AM,CM,PAS,TH1321,and higher re-sensitive rates;higher retreated resistant rates of KM,LOF,OFX. Conclusion THE first-line anti-tuberculosis drug resistant rates of tuberculosis patients in Huizhou are high,which need to be further strengthen to the prevent and control the drug-resistant tuberculosis. Retreated tuberculosis patients had a remainly higher drug resistance,which should pay more atten-tion to,including clinical management and treatment. AM,CM,PAS,TH1321 are recommended for the treatment of multi-drug resistant tuberculosis patients. Monitoring the drug resistance of m