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

Abstract:

Objective To explore the drug resistance of Mycobacterium tuberculosis(MTB) isolated from smear-positive pulmonary tuberculosis (TB) patients in Shaanxi Province.Methods Twenty-six survey points in Shaanxi Province were extracted with stratified cluster random sampling. All the culture positive isolated strains from new smear positive pulmonary TB patients registered from January 2017 to December 2018 were collected. Twenty-two strains were identified as non-tuberculosis mycobacteria (NTM) which accounted for 2.23% (22/987), and 965 strains were identified as MTB which accounted for 97.77% (965/987). Drug susceptibility test of 6 anti-TB drugs (including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), ofloxacin (Ofx), kanamycin (Km)) with proportional method were performed on 965 strains of MTB. SPSS 18.0 was used for statistical analysis, and the counting data were analyzed by Chi-square test or Fisher exact test. P<0.05 was considered statistically significant.Results The drug resistance rate of 965 MTB strains was 28.50% (275/965), 26.07% (219/840) for initially-treated patients and 44.80% (56/125) for re-treated patients. The mono-resistance rate was 14.30% (138/965), 14.76% (124/840) for initially-treated patients and 11.20% (14/125) for re-treated patients. The poly-drug resistance rate was 4.56% (44/965), 4.40% (37/840) for initially-treated patients and 5.60% (7/125) for re-treated patients. The multi-drug resistance rate was 6.53% (63/965), 4.40% (37/840) for initial patients and 20.80% (26/125) for re-treated patients. The extensive drug resistance rate was 0.62% (6/965), 0.24% (2/840) for initially-treated patients and 3.20% (4/125) for re-treated patients. The rifampicin resistance rate was 9.84% (95/965), 7.14% (60/840) for initially-treated patients and 28.00% (35/125) for re-treated patients. The drug resistance rate, multi-drug resistance rate and rifampicin resistance rate of re-treated patients were significantly higher than those of initially-treated patients (χ²=18.730, 47.930 and 53.331 respectively, all P=0.000). The drug resistance rate to 4 first-line and 2 second-line anti-TB drugs were 26.01% (251/965) and 8.50% (82/965), respectively. It showed the highest resistance to Sm (17.62%, 170/965), followed by INH (15.03%, 145/965), RFP (9.84%, 95/965), Ofx (6.84%, 66/965), EMB (5.08%, 49/965) and Km (2.59%, 25/965).There were 39 types of drug resistance spectrum, which included 6 mono-resistance, 5 poly-drug resistance, 13 multi-drug resistance and 15 kinds of poly-drug resistance of second-line drugs.Conclusion In recent years, some achievements have been made in the prevention and control of drug-resistant TB in Shaanxi Province, but the drug resistance spectrum presents polymorphism and complexity, and the epidemic of multi-drug resistance and rifampicin resistance is still severe.

Key words: Tuberculosis, pulmonary, Microbial sensitivity tests, Tuberculosis, multi-drug resistant, Data interpretation, statistical, Shaanxi Province