河南省1 074株结核分枝杆菌药敏特征分析

目的 了解河南省肺结核患者的耐药情况，为制定耐药结核病防控策略提供参考依据。方法 收集2018年河南省25个县（市、区）结核病定点医疗机构分离的结核分枝杆菌，采用《结核分枝杆菌药物敏感性试验标准化操作程序及质量保证手册》中的比例法，开展对异烟肼（INH）、利福平（RFP）、链霉素（SM）、乙胺丁醇（EMB）、氧氟沙星（OFX）、卡那霉素（KM）、卷曲霉素（CPM）、对氨基水杨酸（PAS）、丙硫异烟胺（PTO）9种抗结核药物的敏感度试验，分析菌株的耐药情况。结果 结核分枝杆菌1 074株，总耐药率为26.07%（280/1 074），单耐药146株（13.59%），耐多药61株（5.68%），多耐药73株（6.8%），广泛耐药9株（0.84%）；一线药物耐药以SM（15.64%）、INH（12.29%）为主，二线药物耐药以OFX（5.4%）、KM（4%）为主。初治患者对一线药物INH、RFP、EMB、SM的耐药率均低于复治患者（χ2 = 31.754，49.153，50.524，10.499；P＜0.001，0.001，0.001，P = 0.001），初治患者中对二线药物KM和PAS的耐药率低于复治患者（χ2 = 4.569，5.655；P = 0.033，0.017）；72例RFP耐药的患者中，61例（84.7%）患者同时耐INH（即耐多药，MDR），在所有的61例MDR肺结核患者中，初治患者占52.46%（32/61）。OFX耐药率（32.79%）高于CPM耐药率（11.48%）和OFX、CPM同时的耐药率（9.84%）（χ2 =13.531，P = 0.001），我省在使用OFX和CPM治疗肺结核患者时应加强用药规范性。结论 河南省结核分枝杆菌的总耐药、耐多药、OFX和CPM的耐药情况较为严重，应加强防控措施，以减少耐药结核病的产生和传播。

Characterization of drug sensitivity of 1 074 Mycobacterium tuberculosis strains in Henan Province

Objective To understand the drug resistance of tuberculosis patients in Henan Province, and to provide reference for the formulation of drug-resistant TB prevention and control strategies according to local conditions. Methods Mycobacteria isolated from 25 designated tuberculosis medical institutions in Henan province in 2018 were collected. With reference to the proportion method of Handbook of standardized Operating Procedures and Quality Assurance for Mycobacterium tuberculosis (M. tuberculosis) drug sensitivity tests, the sensitivity tests of 9 antituberculous drugs Isoniazid (INH), Rifampicin (RFP), Streptomycin (SM), Ethambutol (EMB), Ofloxacin (OFX), kanamycin (KM), Capreomycin (CPM), P-aminosalicylic acid (PAS), Protionamide (PTO) were carried out. The drug resistance of the strains was analyzed. Results The total drug resistance rate was 26.07% (280/1 074) for 1 074 strains of Mycobacterium tuberculosis, with 146 (13.59%) mono-resistant strains, 61 (5.68%) multidrug-resistant strains, 73 (6.8%) multidrug-resistant strains, and 18 (1.68%) extensively drug-resistant strains. First-line drug resistance was dominated by SM (15.64%) and INH (12.29%), and second-line drug First-line drug resistance was dominated by SM (15.64%) and INH (12.29%), and second-line drug resistance was dominated by OFX (5.4%) and KM (4%). The rates of resistance to first-line drugs INH, RFP, EMB, and SM were lower in primary patients than in retreatment patients (χ2=31.754, 49.153, 50.524, 10.499; P<0.001, 0.001, 0.001, P=0.001), and the rates of resistance to second-line drugs KM and PAS were lower in primary patients than in retreatment patients (χ2=4.569, 5.655; P=0.033, 0.017). Sixty-one (84.7%) of the 72 RFP-resistant patients were concurrently resistant to INH (i.e., multidrug resistant, MDR), and among all 61 MDR TB patients, 52.46% (32/61) were primary care patients. The rate of OFX resistance (32.79%) was higher than that of CPM resistance (11.48%) and the drug resistance rate of OFX and CPM simultaneously (9.84%) (χ2=13.531, P=0.001), and the standardization of drug use should be enhanced in the treatment of TB patients with OFX and CPM in our province. Conclusion The total drug resistance, multidrug-resistant, OFX and CPM resistance of M. tuberculosis are severe in Henan Province. Prevention and control measures should be strengthened to reduce the emergence and spread of drug-resistant TB.