Email Alert | RSS    帮助

中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (4): 364-369.doi: 10.3969/j.issn.1000-6621.2021.04.012

• 论著 • 上一篇    下一篇

2014—2018年湖南省耐药监测点结核分枝杆菌耐药监测结果分析

白桦, 郭婧玮, 胡培磊, 易松林, 文佳, 刘丰平, 谭云洪(), 白丽琼()   

  1. 410013 长沙,湖南省胸科医院
  • 收稿日期:2021-01-23 出版日期:2021-04-10 发布日期:2021-04-09
  • 通信作者: 谭云洪,白丽琼 E-mail:1220163360@qq.com;liqiong99@126.com
  • 基金资助:
    湖南省科技厅科研计划项目(2013SK3225)

Analysis of drug resistance surveillance results of Mycobacterium tuberculosis in Hu’nan Province from 2014 to 2018

BAI Hua, GUO Jing-wei, HU Pei-lei, YI Song-lin, WEN Jia, LIU Feng-ping, TAN Yun-hong(), BAI Li-qiong()   

  1. Hu’nan Chest Hospital, Changsha 410013, China
  • Received:2021-01-23 Online:2021-04-10 Published:2021-04-09
  • Contact: TAN Yun-hong,BAI Li-qiong E-mail:1220163360@qq.com;liqiong99@126.com

摘要:

目的 了解2014—2018年湖南省结核病耐药监测点分离的结核分枝杆菌的耐药谱,分析耐药变化趋势。方法 菌株分离自2014—2018年湖南省5个国家结核病耐药监测点登记的痰涂片阳性肺结核连续病例,共获得结核分枝杆菌复合群菌株1463株。对结核分枝杆菌复合群菌株进行异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(Sm)、卡那霉素(Km)和氧氟沙星(Ofx)共6种抗结核药品的药物敏感性试验(简称“药敏试验”),描述菌株的耐药谱并分析耐药特征变化情况。结果 1463株结核分枝杆菌复合群菌株中,1244株(85.0%)分离自初治肺结核患者,219株(15.0%)分离自复治肺结核患者。有252株至少对1种及以上药品耐药,总耐药率为17.2%(252/1463)。单耐药率为9.0%(131/1463),耐多药率为5.1%(74/1463),多耐药率为3.2%(47/1463),耐药谱由30种不同耐药类型构成。耐药菌株对6种抗结核药品的任何耐药率从高到低依次为INH(9.9%,145/1463)、Sm(8.2%,120/1463)、RFP(7.0%,103/1463)、Ofx(5.2%,76/1463)、EMB(2.3%,34/1463)和Km(0.8%,12/1463);各药品耐药率比较,差异有统计学意义(χ2=318.838,P=0.001)。2014—2018年各年度分离菌株对RFP耐药比率分别为48.4%(15/31)、45.3%(34/75)、40.0%(20/50)、46.3%(19/41)、27.3%(15/55),呈下降趋势,差异有统计学意义( χ 趋势 2 =7.028,P=0.008);耐药率分别为15.7%(31/198)、20.2%(75/371)、21.5%(50/233)、17.3%(41/237)和13.0%(55/424),呈下降趋势,差异有统计学意义( χ 趋势 2 =3.850,P<0.05)。分离自复治患者的菌株耐药率(28.8%,63/219)和耐多药率(12.8%,28/219)均明显高于分离自初治患者的菌株[耐药率为15.2%(189/1244);耐多药率为3.7%(46/1244)],差异均有统计学意义(χ2=24.065,P<0.01;χ2=32.024,P<0.01)。结论 湖南省结核病耐药监测点分离的结核分枝杆菌复合群菌株耐药处于中等水平且耐药率整体上呈逐年下降趋势。复治结核病患者的耐药率和耐多药率均高于初治患者。

关键词: 分枝杆菌,结核, 抗药性, 人群监测

Abstract:

Objective To explore the drug resistance spectrum of Mycobacterium tuberculosis isolated from the drug-resistance surveillance sites in Hu’nan Province from 2014 to 2018, and to analyze the change trend of drug resistance. Methods A total of 1463 strains of Mycobacterium tuberculosis complex were isolated from sputum smear-positive tuberculosis cases registered in 5 national tuberculosis drug resistance monitoring sites in Hu’nan Province from 2014 to 2018. Drug sensitivity test was carried out on Mycobacterium tuberculosis complex strains. The tested drugs included isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km) and ofloxacin (Ofx). The drug resistance spectrum of the strains was described and the changes of characteristics of drug resistance were analyzed. Results Among the 1463 strains, 1244 (85.0%) were isolated from new tuberculosis patients and 219 (15.0%) were isolated from retreated tuberculosis patients. A total of 252 strains were resistant to at least one drug, and the rate of total drug resistance was 17.2% (252/1463), the rate of mono-drug resistance was 9.0% (131/1463), the rate of multi-drug resistance was 5.1% (74/1463) and the poly-drug resistance rate was 3.2% (47/1463). The drug resistance spectrum of the six anti-tuberculosis drugs consisted of 30 different types of drug resistance. Resistance rate of the six drugs were INH 9.9% (145/1463), Sm 8.2% (120/1463), RFP 7.0% (103/1463), Ofx 5.2% (76/1463), EMB 2.3% (34/1463) and Km 0.8% (12/1463), respectively, the difference was statistically significant (χ2=318.838, P=0.001). From 2014 to 2018, the drug resistance rates of isolates to RFP were 48.4% (15/31), 45.3% (34/75), 40.0% (20/50), 46.3% (19/41), and 27.3% (15/55), respectively, showing a downward trend ( χ trend 2 =7.028, P=0.008); the drug resistance rates were 15.7% (31/198), 20.2% (75/371), 21.5% (50/233), 17.3% (41/237) and 13.0% (55/424), respectively, which also showed a downward trend ( χ trend 2 =3.850, P<0.05). The drug resistance rate and multi-drug resistance rate in strains isolated from retreatment tuberculosis cases were significantly higher than those of the strains isolated from new tuberculosis cases (28.8% (63/219) vs. 15.2% (189/1244), χ2=24.065, P<0.01; 12.8% (28/219) vs. 3.7% (46/1244), χ2=32.024, P<0.01). Conclusion The drug resistance of Mycobacterium tuberculosis in Hu’nan Province was at a medium level and the drug resistance rate showed a decreasing trend year by year. The rates of drug resistance and multi-drug resistance in the re-treated patients were higher than those in the newly treated patients.

Key words: Mycobacterium tuberculosis, Drug resistance, Population surveillance