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中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (9): 940-946.doi: 10.19982/j.issn.1000-6621.20220178

• 论著 • 上一篇    下一篇

231例脊柱结核患者耐药情况分析

王潮虹, 孙晴, 廖鑫磊, 晏君, 王晨倩, 姜广路, 王芬, 薛毅, 黄海荣, 王桂荣()   

  1. 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所/国家结核病临床实验室/北京市耐药结核病研究重点实验室,北京101149
  • 收稿日期:2022-05-12 出版日期:2022-09-10 发布日期:2022-09-05
  • 通信作者: 王桂荣 E-mail:wangguirong1230@ccmu.edu.cn
  • 基金资助:
    北京市通州区科技计划项目(KJ2022CX044);北京市高层次公共卫生技术人才建设项目(2022-3-040);北京市通州区高层次人才发展支持计划(YH201917)

Analysis of drug resistance situation of Mycobacterium tuberculosis strains from 231 spinal tuberculosis patients

Wang Chaohong, Sun Qing, Liao Xinlei, Yan Jun, Wang Chenqian, Jiang Guanglu, Wang Fen, Xue Yi, Huang Hairong, Wang Guirong()   

  1. Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Institute/National Clinical Laboratory On Tuberculosis/Beijng Key Laboratory for Drug Resistant Tuberculosis,Beijing 101149,China
  • Received:2022-05-12 Online:2022-09-10 Published:2022-09-05
  • Contact: Wang Guirong E-mail:wangguirong1230@ccmu.edu.cn
  • Supported by:
    Beijing Tongzhou Municipal Science and Technology commission(KJ2022CX044);Beijing High Level Public Health Technical Talents Construction Project(2022-3-040);Beijing Tongzhou District High Level Talent Development Support Plan(YH201917)

摘要:

目的: 分析231例脊柱结核患者的耐药特点,为临床医生制定脊柱结核治疗方案提供参考。 方法: 回顾性分析2016年1月至2021年12月首都医科大学附属北京胸科医院收治的231例脊柱结核住院患者信息,采用分枝杆菌微孔板药物敏感性检测技术测定来自231例脊柱结核患者的结核分枝杆菌对链霉素(Sm)、异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、利福喷丁(Rft)、左氧氟沙星(Lfx)、阿米卡星(Am)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸异烟肼(Pa)、莫西沙星(Mfx)、对氨基水杨酸(PAS)、克拉霉素(Clr)、利福布汀(Rfb)、卡那霉素(Km)和氯法齐明(Cfz)的敏感性。 结果: 脊柱结核患者对16种药物的总耐药率为34.63%(80/231), 复治患者的总耐药率(75.44%, 43/57)显著高于初治患者(21.26%, 37/174), 差异有统计学意义(χ2=55.660,P<0.001)。脊柱结核患者任一耐药率顺位为:Sm(24.68%, 57/231)>INH(22.51%,52/231)>Rft(19.05%, 44/231)>RFP(18.18%, 42/231)>Pa(15.58%, 36/231)>Rfb(13.85%, 32/231)>Lfx(7.79%, 18/231)>PAS(7.36%, 17/231)>Cm(5.63%, 13/231)>Km(4.76%, 11/231)=Cfz(4.76%, 11/231)>Pto(4.33%, 10/231)=Clr(4.33%,10/231)>EMB(3.90%, 9/231)>Am(3.46%,8/231)>Mfx(2.60%, 6/231)。脊柱结核患者多耐药率为11.69%(27/231), 复治患者的多耐药率(19.30%, 11/57)显著高于初治患者(9.20%, 16/174),差异有统计学意义(χ2=4.246, P=0.039); 耐多药率为15.58%(36/231),复治患者的耐多药率(52.63%, 30/57)显著高于初治患者(3.45%, 6/174), 差异有统计学意义(χ2=46.980, P<0.001)。 结论: 脊柱结核存在严重的耐药问题, 临床医生应根据患者药物敏感性试验结果制定有效的治疗方案。

关键词: 结核,脊柱, 微生物敏感性试验, 结核,抗多种药物性, 数据说明,统计

Abstract:

Objective: To analyze the drug resistance characteristics of 231 patients with spinal tuberculosis and to provide reference for clinicians to develop proper treatment regimens for spinal tuberculosis patients. Methods: The Mycobacterium tuberculosis strains and clinical data were collected from 231 culture-positive spinal tuberculosis patients, who were hospitalized in Beijing Chest Hospital from January 2016 to December 2021. Drug susceptibility test was performed for the following 16 drugs using ENCODE microplate methods: streptomycin (Sm), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), rifapentine (Rft), levofloxacin (Lfx), amikacin (Am), capreomycin (Cm), prothionamide (Pto), isoniazid aminosalicylate (Pa), moxifloxacin (Mfx), p-aminosalicylic acid (PAS), clarithromycin (Clr), rifabutin (Rfb), kanamycin (Km) and clofazimine (Cfz). Results: The total drug resistance rate of those spinal tuberculosis patients to at least one of the 16 drugs was 34.63% (80/231), of which the drug resistance rate was significantly higher in previously treated patients (75.44%, 43/57) than in new patients (21.26%, 37/174), and the difference was statistically significant (χ2=55.660, P<0.001). The drug resistance rates of spinal tuberculosis patients to the 16 drugs from high to low were: Sm (24.68%, 57/231)>INH (22.51%, 52/231)>Rft (19.05%, 44/231)>RFP (18.18%, 42/231)>Pa (15.58%, 36/231)>Rfb (13.85%, 32/231)>Lfx (7.79%, 18/231)>PAS (7.36%, 17/231)>Cm (5.63%, 13/231)>Km (4.76%, 11/231)=Cfz (4.76%, 11/231)>Pto (4.33%, 10/231)=Clr (4.33%, 10/231)>EMB (3.90%, 9/231)>Am (3.46%, 8/231)>Mfx (2.60%, 6/231). The poly-drug resistance rate of spinal tuberculosis patients was 11.69% (27/231), of which the poly-drug resistance rate was significantly higher in previously treated patients (19.30%, 11/57) than in new patients (9.20%, 16/174),and the difference was statistically significant (χ2=4.246, P=0.039); The multidrug-resistance rate was 15.58% (36/231), of which the multidrug-resistance rate was significantly higher in previously treated patients (52.63%, 30/57) than in new patients (3.45%, 6/174),and the difference was statistically significant (χ2=46.980, P<0.001). Conclusion: There was serious epidemic of drug resistance in spinal tuberculosis patients. Effective treatment regimens should be developed according to the results of drug susceptibility tests.

Key words: Tuberculosis,spine, Microbial sensitivity tests, Tuberculosis,multidrug-resistant, Data interpretation,statistical

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