894株结核分枝杆菌对一线抗结核药物的耐药情况分析

doi:10.3969/j.issn.1000-6621.2019.03.023

摘要/Abstract

摘要：

收集2016年1月至2018年3月吉林省9个市(州)894例肺结核患者痰标本中的结核分枝杆菌临床分离株进行分析。并采用比例法药物敏感性试验(简称“药敏试验”)对全部结核分枝杆菌菌株进行利福平(RFP)、异烟肼(INH)、链霉素(Sm)和乙胺丁醇(EMB)4种一线抗结核药物的药敏试验。结果显示,894株结核分枝杆菌对一线抗结核药物敏感者有546株(61.07%),对一线抗结核药物耐药者有348株(38.93%);其中初治患者的耐药率为36.30%(265/730),低于复治患者的耐药率(50.61%,83/164),差异有统计学意义(χ ²=11.53,P=0.001)。全部患者的总耐多药率为10.07%(90/894),复治患者耐多药率(20.73%,34/164)高于初治患者(7.67%,56/730),差异有统计学意义(χ ²=25.23,P=0.001)。全部患者对一线抗结核药物的耐药率顺位为Sm(25.95%,232/894)>INH(18.57%,166/894)>RFP(17.23%,154/894)>EMB(9.73%,87/894)。吉林省肺结核患者对一线抗结核药物耐药率较高,尤其是复治患者;耐药结核病防治形势依然严峻,需加强结核病的防控工作。

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

Abstract:

The clinical isolates of Mycobacterium tuberculosis in sputum specimens of 894 patients with tuberculosis in 9 Cities (States) of Jilin Province from January 2016 to March 2018 were collected and analyzed. The susceptibility tests of rifampicin (RFP), isoniazid (INH), streptomycin (Sm) and ethambutol (EMB) were carried out. Among 894 strains of Mycobacterium tuberculosis, 546 (61.07%) were susceptible to first-line drugs, 348 (38.93%) were resistant to first-line drugs. The resistance rate was 36.30% (265/730) for initial treatment cases and 50.61% (83/164) for retreatment cases, and the difference was statistically significant (χ ²=11.53, P=0.001). The total multidrug-resistance rate was 10.07% (90/894). The drug resistance rate was higher in retreatment cases (20.73%, 34/164) than initial treatment cases (7.67%, 56/730), and the difference was statistically significant (χ ²=25.23,P=0.001). The drug resistance rate of all patients to first-line anti-TB drugs was Sm (25.95%, 232/894)>INH (18.57%, 166/894)>RFP (17.23%, 154/894)>EMB (9.73%, 87/894). The tuberculosis patients in Jilin Province have high resistance to first-line drugs, especially the retreatment patients. The situation of drug-resistant tuberculosis prevention and control is still serious, and the prevention and control of tuberculosis needs to be strengthened.

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

赵薇,刘思洁,李可维,申莉,刘昕,齐鹏,杨修军. 894株结核分枝杆菌对一线抗结核药物的耐药情况分析[J]. 中国防痨杂志, 2019, 41(3): 364-368. doi: 10.3969/j.issn.1000-6621.2019.03.023

Wei ZHAO,Si-jie LIU,Ke-wei LI,Li SHEN,Xin LIU,Peng QI,Xiu-jun YANG. Analysis of 894 strains of Mycobacterium tuberculosis resistance to first-line anti-tuberculosis drugs[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 364-368. doi: 10.3969/j.issn.1000-6621.2019.03.023

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耐药类型	初治患者(730例)		复治患者(164例)		合计(894例)
耐药类型	例数	耐药率(%)	例数	耐药率(%)	例数	耐药率(%)
任一耐药
耐INH	118	16.16	48	29.27	166	18.57
耐RFP	103	14.11	51	31.10	154	17.23
耐EMB	63	8.63	24	14.63	87	9.73
耐Sm	180	24.66	52	31.71	232	25.95
单一耐药
INH	28	3.84	8	4.88	36	4.03
RFP	24	3.29	9	5.49	33	3.69
EMB	13	1.78	0	0.00	13	1.45
Sm	81	11.10	18	10.98	99	11.07
耐多药
INH+RFP	12	1.64	8	4.88	20	2.24
INH+RFP+Sm	17	2.33	5	3.05	22	2.46
INH+RFP+EMB	5	0.68	6	3.66	11	1.23
INH+RFP+EMB+Sm	22	3.01	15	9.15	37	4.14
多耐药
INH+EMB	3	0.41	0	0.00	3	0.34
INH+Sm	25	3.42	5	3.05	30	3.36
RFP+EMB	0	0.00	0	0.00	0	0.00
RFP+Sm	15	2.05	6	3.66	21	2.35
EMB+Sm	6	0.82	0	0.00	6	0.67
INH+EMB+Sm	6	0.82	1	0.61	7	0.78
RFP+EMB+Sm	8	1.10	2	1.22	10	1.12

临床特征	菌株数	任一耐药
临床特征	菌株数	菌株数	耐药率 (%)	χ²值	P值	菌株数	耐药率 (%)	χ²值	P值
性别				0.18	0.668			1.13	0.289
男	685	264	38.54			73	10.66
女	209	84	40.19			17	8.13
年龄(岁)				0.36	0.835			0.27	0.876
≤30	123	50	40.65			11	8.94
31~	527	201	38.14			55	10.44
≥60	244	97	39.75			24	9.84
治疗史				11.53	0.001			25.23	0.001
初治	730	265	36.30			56	7.67
复治	164	83	50.61			34	20.73