海南省2015年结核病耐药监测结果分析

目的 了解海南省耐药结核病的流行现状,为制定结核病防治工作策略提供科学依据.方法 收集海南省各市(县)2015年1月-12月期间发现的1 543例涂阳肺结核患者的痰标本,进行结核分枝杆菌培养、菌型鉴定.采用比例法进行6种抗结核药物利福平(RFP,R)、异烟肼(INH,H)、链霉素(Sm,S)、乙胺丁醇(EMB,E)、氧氟沙星(Ofx,O)、卡那霉素(KM,K)]的药物敏感性试验.结果 1 543例涂阳肺结核患者中,1 339例为结核分枝杆菌复合群,其中总耐药率为20.9％(280/1 339),初治涂阳肺结核患者总耐药率及复治涂阳肺结核患者总耐药率分别为17.3％(197/1 139)和41.5％(83/200),复治患者总耐药率高于初治患者,两组之间差异有统计学意义(P＜0.01).总单耐药率为10.5％(140/1 339),初治患者单耐药率为10.4％(119/1 139),复治患者为10.5％(21/200),两组间差异无统计学意义(P＞0.05).多耐药率为3.6％(48/1 339),其中初治患者多耐药率为3.6％(41/1 139),复治患者为3.5％(7/200),两组间差异无统计学意义(P＞0.05).总耐多药率为6.9％(92/1 339),其中初治患者耐多药率为3.2％(37/1 139),复治患者为27.5％(55/200),两组间差异有统计学意义(P＜0.01).耐单药率顺位由高到低依次为Sm=INH＞RFP＞Ofx＞EMB＞Km.结论 海南省结核病的耐药情况不容乐观,今后需要采取全面、积极的干预措施遏制耐药结核病的流行.

Analysis of results of tuberculosis drug resistance monitoring in Hainan in 2015

Objective To understand the epidemic situation of drug resistant tuberculosis (TB) in Hainan Province so as to provide evidences for improving future TB prevention and control work.Methods The sputum samples were collected from 1 543 smear positive pulmonary TB patients who were detected in Hainan Institute for Tuberculosis Prevention and Control from January 2015 to December 2015,and then the culture,identification of strains and drug susceptibility testing (DST) of tubercle bacillus to 6 anti-TB drugs isoniazid (INH),streptomycin (Sm),rifampicin (RFP),ethambutol (EMB),ofloxacin (Ofx) and kanamycin (Km)] by using proportion method were performed on all sputum specimens.Results The overall drug resistance rate in Mycobacterium tuberculosis complex strains obtained from 1 339 TB patients was 20.9％ (280/1 339),and of which,the drug resistance rate was 17.3％ (197/1 139) and 41.5％ (83/200) respectivelyfor the initial treatment and retreatment TB patients,and there was statistically significant differences between the two groups (P ＜ 0.01).The monoresistance rate in all TB patients was 10.5％ (140/1 339),and it was 10.4％ (1 19/1 139) and 10.5％ (21/200) respectively for the initial treatment and retreatment TB patients.There was no statistically significant difference between the two groups (P ＞ 0.05).The poly-resistant rate in all TB patients was 3.6％ (48/1 339),and it was 3.6％ (41/1 139) and 3.5％ (7/200) respectively for the initial treatment and retreatment TB patients.There was no statistically significant difference between the two groups (P ＞ 0.05).The multidrug-resistant (MDR) rate in all the TB patients was 6.9％ (92/1 339),and it was 3.2％ (37/1 139) and 27.5％ (55/200) respectively for the initial treatment and retreatment TB patients.The difference between the two groups was statistically significant (P ＜ 0.01).The single drug resistance rate of the sequence from high to low in turn was Sm=INH＞RFP＞Ofx＞EMB＞Km.Conclusions The TB drug resistance situation is not optimistic in Hainan Province.In the future,we should take comprehensive measures to curb the prevalence of drug-resistant TB.