北京市肺结核病人耐药筛查实施效果的研究

目的 分析北京市利福平耐药结核病(RR-TB)诊断流程实施效果，为进一步完善耐药结核病的快速筛查和治疗提供依据。方法 选取2019年1月至2019年12月在北京市结核病防治机构及定点医院就诊的表型药物敏感性试验为利福平耐药的86例肺结核患者，评价其诊疗过程中北京市耐药筛查工作的开展情况，并分析其临床分离株对利福平(RFP)、异烟肼(INH)、左氧氟沙星(LFX)的表型药敏试验的耐药情况。结果 2019年86例RR-TB中Xpert检出62例利福平耐药，Hain检测补充检出3例，另外3例阳性培养物直接进行了表型药敏试验，通过耐药筛查工作RR-TB患者的发现率为79.07%(68/86),漏诊率为20.93%(18/86)。其中，8例Xpert为利福平敏感而表型药敏为利福平耐药，漏筛率为11.63%(10/86)。RR-TB中准广泛耐药率为23.26%(20/86),初复治在3种不同耐药类型中差异无统计学意义。结论 北京市耐药筛查工作在RR-TB诊断中具有快速高效的特点，存在一定的分子耐药与表型不一致现象，且实施中工作落实有待提高，需进一步加强督促管理。pre-XDR-TB处于较高水平，应...

Drug resistance screening of pulmonary tuberculosis patients in Beijing

This study aims to analyze the diagnostic process of rifampicin-resistant tuberculosis (RR-TB) in Beijing, and to provide a basis for further improving the rapid screening and treatment of drug-resistant tuberculosis. A total of 86 patients with RR-TB diagnosed by phenotypic drug susceptibility test,who were treated in Beijing tuberculosis prevention and control institutions and assigned hospitals from January to December 2019 were included. The investigation was to evaluate the resistance screening of drug resistance in Beijing during the diagnosis and treatment process. The resistance of clinical isolates to rifampicin(RFP) isoniazid (INH) and levofloxacin (LFX) by phenotypic drug susceptibility test was analyzed. Among 86 cases of RR-TB in 2019, 62 cases of rifampicin resistance were detected by Xpert, three cases were detected by Hain supplementation, and the positive cultures of the other three cases were directly subjected to phenotypic drug susceptibility testing. The detection rate of patients with RR-TB in the screening was 79.07% (68/86), and the missed diagnosis rate was 20.93% (18/86). Among these,eight cases of Xpert were rifampicin-sensitive and phenotype drug-susceptibility was rifampicin-resistant, and the missed screening rate was 11.63% (10/86). The rate of pre-extensive drug resistance in RR-TB was 23.26% (20/86), and there was no significant difference in the newly diagnosed and retreated patients among the three different drug resistance types. The drug resistance screening work in Beijing is fast and efficient in the diagnosis of RR-TB. However there is a certain inconsistency between molecular drug resistance and phenotype, and the implementation of the work needs to be improved, and further supervision and management need to be strengthened. Pre-XDR-TB is at a high level, and molecular diagnosis of fluoroquinolones should be carried out as soon as possible.