初治活动性肺结核患者耐药性分析

目的了解初治活动性肺结核患者耐药状况,为初治活动性肺结核的临床诊治提供依据。方法收集2013年8月至2014年2月广东省佛山市禅城区结核病控制项目登记的初治活动性肺结核患者203例,对分离出结核分枝杆菌菌株84例进行一线抗结核药物(Sm、INH、RFP、EMB)耐药情况检测并进行分析。耐药率之间的差异性比较采用SPSS16.0统计软件的χ2检验,P0.05为差异有统计学意义。结果 84株结核分枝杆菌的总耐药率为16.67%(14/84),初治涂阳肺结核患者耐药率为20%(11/55),初治涂阴肺结核患者耐药率为10.34%(3/29);总耐多药率为5.95%(5/84),初治涂阳肺结核患者耐多药率为7.27%(4/55),初治涂阴肺结核患者耐多药率为3.45%(1/29)。初治涂阳肺结核患者抗结核药物耐药率顺位为SmINHRFPEMB[Sm 16.36%(9/55)、INH 14.55%(8/55)、RFP 7.27%(4/55)、EMB 3.64%(2/55)],初治涂阴肺结核患者顺位为INHSmRFP=EMB[Sm 6.90%(2/29)、INH 10.34%(3/29)、RFP 3.45%(1/29)、EMB3.45%(1/29)]。男性耐药率为22.64%(12/53)、女性耐药率为(6.45%(2/31)。初治涂阳与涂阴肺结核患者总耐药率差异无统计学意义(χ2=0.674,P0.05);初治活动性肺结核患者不同性别耐药率差异无统计学意义(χ2=3.691,P0.05)。结论初治活动性肺结核患者耐药状况不容乐观,应加强对现有临床诊治方法的研究。

Analysis of drug resistance of initial-treated patients with active pulmonary tuberculosis

Objective To understand the drug resistance of initial-treated patients with active pulmonary tu-berculosis. Methods 203 first-treated patients with active pulmonary tuberculosis in Guangdong Province from 2013 August to 2014 February were selected in this study, and 84 strains of Mycobacterium tuberculosis were isolated and given the first-line anti-TB drug(Sm, INH, RFP and EMB)susceptibility test. The difference between the resistant rates was analyzed by χ2 test, and the significance level was set at P<0. 05. Results The total resistance rate was 16. 67%(14/84). The resistance rate of new smear positive pulmonary tuberculosis patients was 20%(11/55)and 10. 34%(3/29)for initial treated smear negative patients. The rate of MDR-TB was 5. 95%(5/84), with the new smear positive pulmonary tuberculosis rate of MDR-TB being 7. 27%(4/55)and the initial treated smear negative rate of MDR-TB being 3. 45%(1/29). The drug resistance of tuberculosis patients with new smear positive pulmona-ry tuberculosis were as follows: Sm >INH >RFP > EMB, Sm 16. 36%(9/55), INH 14. 55%(8/55), RFP 7. 27%(4/55), and EMB 3. 64%(2/55), while the initial treated smear negative patients were as follows:INH>Sm>RFP=EMB, Sm 6. 90%(2/29), INH 10. 34%(3/329), RFP 3. 45%(1/29)and EMB 3. 45%(1/29). The resistance of male patients was 22. 64%(12/53), and female was 6. 45%(2/31). There was no significant difference in the total drug resistance and sexual drug resistance(χ2 =0. 674, P>0. 05, χ2 =3. 691, P>0. 05). Conclusion The drug resistance of initial-treated patients with active pulmonary tuberculosis is serious, which should be paid more attention to strengthen the study of the existing clinical diagnosis and treatment.