新疆喀什地区1307例肺结核患者行利福平和异烟肼耐药性检测的结果分析

目的 分析新疆维吾尔自治区喀什地区结核病患者行利福平和异烟肼耐药性检测的结果。 方法 搜集2019年1月1日至6月30日喀什地区11个市(县)根据《WS 288—2017 肺结核诊断》确诊的1307例患者的痰培养标本及患者信息,利用结核分枝杆菌利福平耐药突变检测试剂盒和结核分枝杆菌异烟肼耐药突变检测试剂盒对利福平和异烟肼进行耐药性检测,对不同年龄组、不同性别、不同治疗史、不同地区患者对两种药品的耐药情况进行统计分析。计数资料组间比较采用χ²检验,以P<0.05为差异有统计学意义。 结果 在1307例患者中,利福平耐药198例,耐药率为15.15%;异烟肼耐药151例,耐药率为11.55%;耐多药63例,耐多药率为4.82%。男性与女性患者利福平耐药率[15.71%(110/700)和14.57%(88/604)]、异烟肼耐药率[10.71%(75/700)和12.42%(75/604)]和耐多药率[4.57%(32/700)和5.13%(31/604)]差异均无统计学意义(χ²=0.330,P=0.566;χ²=0.924,P=0.337;χ²=0.222,P=0.638)。初治和复治患者利福平耐药率[15.46%(160/1035)和16.32%(31/190)]、异烟肼耐药率[11.30%(117/1035)和14.74%(28/190)]和耐多药率[4.73%(49/1035)和6.32%(12/190)]差异均无统计学意义(χ²=0.090,P=0.765;χ²=1.812,P=0.178;χ²=0.849,P=0.357)。60~70岁年龄组耐多药率最高(6.12%,21/343);30~40岁年龄组对利福平和异烟肼耐药率均最高,分别为21.32%(29/136)和14.71%(20/136)。喀什地区11个市(县)中,喀什市耐多药率(10.59%,9/85)、利福平耐药率(25.88%,22/85)和异烟肼耐药率(28.24%,24/85)均为最高。 结论 喀什地区耐药结核病状况较为严重,应加强耐药性筛查力度,及时发现耐药结核病患者,并制订有效的化疗方案。

Analysis of drug-resistance to rifampin and isoniazid in 1307 patients with pulmonary tuberculosis in Kashi,Xinjiang

Objective To analyze the drug susceptible test results to rifampin and isoniazid among the patients with pulmonary tuberculosis (PTB) in Kashi, Xinjiang. Methods The sputum samples and patients’ information were collected from 1307 PTB patients, who were diagnosed from January 1, 2019 to June 30, 2019 in 11 cities/counties in Kashi, Xinjiang according to the Diagnosis standard of pulmonary tuberculosis (WS 288—2017). The drug susceptible test to rifampin and isoniazid were performed by using gene mutation detection kits for rifampin resistance and isoniazid resistance. The statistical analysis of drug resistance situation in patients with different age groups, different genders, different treatment histories and different regions was conducted. Chi-square test was used to compare the differences of drug resistance rate between different patient groups. A P-value <0.05 was considered as statistically significant. Results Among 1307 patients, 198 cases were resistant to rifampin and the drug resistance rate was 15.15%; 151 cases were resistant to isoniazid and the drug resistance rate was 11.55%; 63 cases were resistant to both rifampin and isoniazid and the multidrug-resistance (MDR) rate was 4.82%. There were no statistically significant differences of rifampin resistant rate, isoniazid resistant rate and MDR rate between male and female patient groups (rifampin, 15.71% (110/700) vs 14.57% (88/604), χ²=0.330, P=0.566; isoniazid, 10.71% (75/700) vs 12.42% (75/604), χ ²=0.924, P=0.337; MDR, 4.57% (32/700) vs 5.13% (31/604), χ ²=0.222, P=0.638). There were no statistically significant differences of rifampin resistant rate, isoniazid resistant rate and MDR rate between new and retreated patient groups (rifampin, 15.46% (160/1035) vs 16.32% (31/190), χ ²=0.090, P=0.765; isoniazid, 11.30% (117/1035) vs 14.74% (28/190), χ ²=1.812, P=0.178; MDR, 4.73% (49/1035) vs 6.32% (12/190), χ ²=0.849, P=0.357). The MDR rate was the highest among the patient group aging 60-70 (6.12%, 21/343). The highest rifampin resistance rate (21.32%, 29/136) and the highest isoniazid resistance rate (14.71%, 20/136) were found to be in the patient group aging 30-40. The highest rates of MDR (10.59%, 9/85), rifampin resistance (25.88%, 22/85) and isoniazid resistance (28.24%, 24/85) were found in Kashi City among the 11 cities/counties in Kashi area. Conclusion The situation of drug-resistant TB is relatively serious in Kashi. Drug-resistance screening should be strengthened to timely detect drug-resistant TB patients and effective chemotherapy regimens should be designed and provided.