人类免疫缺陷病毒/结核分枝杆菌双重感染者结核分枝杆菌分离株一线药物耐药特征

目的分析人类免疫缺陷病毒(HIV)感染者的结核分枝杆菌(MTB)分离株对一线抗结核分枝杆菌药物的耐药特征，为临床治疗HIV/MTB双重感染提供参考依据。 方法选取上海市公共卫生临床中心2012年1月至2016年12月收治的HIV合并MTB感染者154例(实验组)和单纯结核分枝杆菌感染者357例(对照组)，进行异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(STR)4种一线药物耐药性检测，比较两组患者MTB的总耐药率和总耐多药率，初始及获得性耐药、耐多药率。 结果HIV/MTB双重感染组患者总耐药率(44.2%，68/154)、初始耐药率(42.2%，19/45)、初始耐多药率(13.3%，6/45)、STR总耐药率(31.8%，49/154)和初始耐药率(28.9%，13/45)显著高于单纯结核分枝杆菌感染组(33.9%、25.0%、3.8%、22.7%、11.4%)(P均<0.05)。INH、RFP、EMB耐药率与单纯结核分枝杆菌感染组差异无统计学意义(P均> 0.05)。单纯结核分枝杆菌感染组患者获得性耐药率(39.1%，88/225)和获得性耐多药率(19.1%，43/225)分别高于初始耐药率(25.0%，33/132)和初始耐多药率(3.8%，5/132)(χ²= 16.785、P < 0.001；χ²= 7.393、P = 0.004)。 结论HIV/MTB感染者分离的MTB对一线抗结核分枝杆菌药物耐药率和耐多药率高，其中STR耐药最为严重，提示临床治疗应重视HIV/MTB双重感染者的结核耐药问题，及时采取预防措施和制定个体化治疗方案。

First-line drug resistance characteristics of Mycobacterium tuberculosis isolates from patients with human immunodeficiency virus/ Mycobacterium tuberculosis coinfection

ObjectiveTo investigate the drug resistance characteristics ofMycobacterium tuberculosis (MTB) isolates to four first-line antituberculous drugs from patients with human immunodeficiency virus (HIV)/MTB coinfection, and to guide the clinical treatment. MethodsMTB strains were isolated from 154 cases with HIV/MTB coinfection (experimental group) and 357 cases with HIV-negative tuberculosis (control group) who were admitted to Shanghai Public Health Clinical Center between January 2012 and December 2016. The drug resistance patterns to isoniazide (INH), rifampicin (RFP), ethambutol (EMB) and streptomycin (STR) were analyzed. The total drug resistance, multi-drug resistance, initial resistance and acquired drug resistance were compared, respectively. ResultsAmong the 154 MTB isolates from tuberculosis patients with HIV infection, the rate of total resistance (44.2%, 68/154), initial resistance (42.2%, 19/45) initial multidrug-resistance (13.3%, 6/45), STR total resistance (31.8%, 49/154) and STR initial drug resistance (28.9%, 13/45) were significantly higher than those of TB patients without HIV infection (33.9%, 25.0%, 3.8%, 22.7%, 11.4%, respectively; allP < 0.05). While the resistance to INH, RFP, EMB showed no statistically significant difference between the two groups (allP> 0.05). Among patients with TB without HIV infection, the rate of acquired drug resistance (39.1%, 88/225) and acquired multidrug-resistance (19.1%, 43/225) were significantly higher than initial resistance (25.0%, 33/132) and initial multidrug-resistance (3.8%, 5/132) (χ²= 16.785,P< 0.001;χ²= 7.393,P= 0.004). ConclusionsThe situation of drug resistance and multidrug resistance in HIV/MTB coinfected patients was serious, especially STR, which indicated that clinicians should pay attention to MTB drug resistance in HIV infected patients and take timely preventive measures as well as individual treatment.