重庆市638例肺结核患者耐药流行现状分析

目的了解重庆市638例肺结核患者耐药流行现状与流行特点,为下一步耐药肺结核病防控提供依据。方法对2015年重庆市结核病参比实验室收集的638例涂阳肺结核痰培养标本进行异烟肼、利福平、乙胺丁醇、链霉素、氧氟沙星和卡那霉素等6种抗结核药物敏感试验检测,对其结果进行分析。结果 638例涂阳肺结核患者总耐药为35.6%,耐多药率为23.8%,复治涂阳肺结核患者的总耐药率和耐多药率(44.3%和28.8%)均高于初治涂阳肺结核患者(16.1%和8.7%,P0.05);5类高危人群的总耐药率和耐多药率均高于新患者(P0.05)。女性肺结核患者的总耐药率和耐多药率高于男性患者(P0.05);不同年龄组、地区的总耐药率和耐多药率差异有统计学意义(P0.05);检测的6种抗结核病药物耐药顺位由高到低依次为利福平、异烟肼、链霉素、氧氟沙星、乙胺丁醇和卡那霉素,单耐药以利福平耐药为主(74.2%),多耐药以异烟肼和链霉素耐药为主(72.7%),耐多药中耐利福平和异烟肼占45.4%。结论重庆市耐药结核病高危人群和重点地区的耐药流行较为严重,应加强耐药结核病的发现和治疗管理工作;同时应加大防治经费投入,采取全面、积极的干预措施遏制耐药结核病的流行。

Prevalence of multidrug-resistance in 638 tuberculosis patients in Chongqing

Objective To understand the prevalence and epidemiological characteristics of drug resistant tuberculosis (TB) in Chongqing City,so as to provide evidences for the prevention and control of drug resistant TB in the future.Methods A total of 638 smear positive specimens of pulmonary TB patients were collected for testing the susceptibilities of 6 anti-TB drugs [isoniazid(INH),rifampicin(RFP),ethambutol(EMB),streptomycin(SM),ofloxacin(OFX) and kanamycin(KM)] in Chongqing City,2015.Results Among the 638 cases tested,the total drug resistant rate was 35.6％.The multidrug-resistant (MDR) rate was 23.8％.The total resistant rate and MDR rate were 44.3％ and 28.8％ respectively in the retreatment TB patients,which were significantly higher than those in the initial treatment patients (16.1％ and 8.7％ respectively,P＜0.05).The total resistant rate and MDR rate in the 5 kinds of high risk population were significantly higher than those in the new TB patients (P＜0.05).The total resistant rate and MDR rate in the female TB patients were significantly higher than those in male TB patients (P＜0.05).There were significant differences among the different age groups and areas.The single drug resistant rate of the sequence from high to low in turn was RFP,INH,SM,OXF,EMB and KM.The single drug resistant rate of RFP was the highest (74.2％),and the MDR rates of INH and SM were the highest (72.7％).RFP and SM were the main drugs with MDR (45.4％).Conclusions The prevalence of drug resistant TB is relatively high in the focus groups and high-risk groups in Chongqing City.Therefore we should strengthen the discovery and treatment management of drug resistant TB patients and increase the funds of prevention and control,so as to reduce the epidemic of drug-resistant TB.