2013—2016年遵义地区870例肺结核患者耐药状况分析

doi:10.3969/j.issn.1000-6621.2018.06.011

摘要/Abstract

摘要： 目的

分析近年来就诊于贵州省遵义医学院附属医院肺结核患者的耐药情况,为耐药结核病的防控提供依据。

方法

选取2013—2016年期间就诊于遵义医学院附属医院的肺结核患者870例,采集患者的痰液及肺泡灌洗液标本,采用罗氏培养及比例法进行4种一线抗结核药物(异烟肼、利福平、乙胺丁醇、链霉素)的药物敏感性试验(简称“药敏试验”),并将患者的耐药情况进行比较分析。

结果

870例肺结核患者中,初治患者611例,复治患者259例;患者总耐药率为26.6%(231/870),耐多药率为12.1%(105/870)。初治患者的总耐药率为16.4%(100/611),复治患者的总耐药率为50.6%(131/259),差异有统计学意义(χ ²=56.74,P<0.01)。初治患者的单耐药率为9.7%(59/611),复治患者的单耐药率为10.0%(26/259),差异无统计学意义(χ ²=0.03,P=0.862)。初治患者的多耐药率为3.1%(19/611),复治患者的多耐药率为8.5%(22/259),差异有统计学意义(χ ²=11.74,P<0.01)。初治患者的耐多药率为3.6%(22/611),复治患者的耐多药率为32.0%(83/259),差异有统计学意义(χ ²=138.69,P<0.01)。

结论

复治增加耐药风险,应加强复治肺结核患者耐药筛查,强调规范化治疗。

关键词: 结核, 肺, 结核, 抗多种药物性, 小地区分析, 对比研究

Abstract: Objective

To understand the situation of drug resistant tuberculosis in the Affiliated Hospital of Zunyi Medical College in order to provide scientific evidence for the drug resistant tuberculosis prevention and control strategies.

Methods

A total of 870 Mycobacterium tuberculosis isolates composed of sputum and bronchoalveolar lavage fluid were collected from patients with pulmonary tuberculosis (PTB) in the Affiliated Hospital of Zunyi Medical College during the years of 2013 to 2016. Drug sensitivity tests against 4 anti-TB drugs (rifampicin, isoniazid, ethambutol and streptomycin) were performed using the Roche culture and proportion method. The demographic and drug resistance information were collected.

Results

Among the 870 cases, 611 cases were new patients and 259 cases were previously treated patients. The total rates of drug resistant and multidrug-resistant (MDR) were 26.6% (231/870) and 12.1% (105/870),respectively. The total drug resistant rates of new and previously treated patients were 16.4% (100/611) and 50.6% (131/259),respectively, and the difference was statistically significant (χ ²=56.74,P<0.01). The single drug resistance rates of new and previously treated patients were 9.7% (59/611) and 10.0% (26/259), respectively, and the difference was not statistically significant (χ ²=0.03, P=0.862). The polyresistance rates of new and previously treated patients were 3.1% (19/611) and 8.5% (22/259),respectively. The difference was statistically significant (χ ²=11.74, P<0.01). The MDR rates of new and previously treated patients were 3.6% (22/611) and 32.0% (83/259), respectively. And the difference was statistically significant (χ ²=138.69, P<0.01).

Conclusion

Retreatment would increase the risk of TB’s resis-tance to drugs. Consequently, there is a urgent call for the improvement of drug resistance screening and standar-dized treatment for retreated PTB patients.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Small-area analysis, Com-parative study

李瑜琴,向敏,陈玲,张建勇,何月娟,李娜娜. 2013—2016年遵义地区870例肺结核患者耐药状况分析[J]. 中国防痨杂志, 2018, 40(6): 604-608. doi: 10.3969/j.issn.1000-6621.2018.06.011

Yu-qin LI,Min XIANG,Ling CHNE,Jian-yong ZHANG,Yue-juan HE,Na-na. LI. Analysis of the drug-resistant status of 870 patients with pulmonary tuberculosis from 2013 to 2016[J]. Chinese Journal of Antituberculosis, 2018, 40(6): 604-608. doi: 10.3969/j.issn.1000-6621.2018.06.011

图/表 2

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一般特征	初治患者(611例)		复治患者(259例)		合计(870例)		χ²值	P值
一般特征	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别							2.62	0.106
男	380	62.2	176	68.0	556	63.9
女	231	37.8	83	32.0	314	36.1
年龄组(岁)							13.04	0.005
<18	35	5.7	3	1.2	38	4.3
18~	175	28.7	78	30.1	253	29.1
40~	192	31.4	101	39.0	293	33.7
≥60	209	34.2	77	29.7	286	32.9
地区							0.09	0.767
贵州省内	605	99.0	257	99.2	862	99.1
贵州省外	6	1.0	2	0.8	8	0.9

耐药类型	初治(611例)		复治(259例)		合计(870例)		χ²值	P值
耐药类型	例数	耐药率 (%)	例数	耐药率 (%)	例数	耐药率 (%)	χ²值	P值
单耐药	59	9.7	26	10.0	85	9.8	0.03	0.862
单耐INH	18	2.9	10	3.9	28	3.2	1.65	0.648
单耐RFP	6	1.0	4	1.5	10	1.1
单耐EMB	6	1.0	3	1.2	9	1.0
单耐Sm	29	4.7	9	3.5	38	4.4
多耐药	19	3.1	22	8.5	41	4.7	11.74	0.001
INH+EMB	1	0.2	0	0.0	1	0.1	0.27	0.786
INH+Sm	8	1.3	8	3.1	16	1.8
RFP+EMB	1	0.2	4	1.5	5	0.6
RFP+Sm	1	0.2	1	0.4	2	0.2
EMB+Sm	3	0.5	2	0.8	5	0.6
RFP+EMB+Sm	0	0.0	4	1.5	4	0.5
INH+EMB+Sm	5	0.8	3	1.2	8	0.9
耐多药	22	3.6	83	32.0	105	12.1	138.69	<0.01
INH+RFP	4	0.7	9	3.5	13	1.5	1.67	0.643
INH+RFP+EMB	3	0.5	19	7.3	22	2.5
INH+RFP+Sm	3	0.5	14	5.4	17	2.0
INH+RFP+EMB+Sm	12	2.0	41	15.8	53	6.1