住院肺结核患者耐氧氟沙星情况分析

摘要/Abstract

摘要： 目的了解肺结核患者痰结核分枝杆菌临床分离株对氧氟沙星的耐药情况，为氧氟沙星在抗结核化疗中的合理应用提供科学依据。方法2007年8月—2008年3月上海市肺科医院收治的痰培养阳性的肺结核患者，全部培养阳性菌株进行菌种鉴定及5种抗结核药物（异烟肼、利福平、氧氟沙星、链霉素、乙胺丁醇）的耐药性测试。结果233例MTB临床株对氧氟沙星耐药率为24.9%，低于对一线药物的耐药率。初治肺结核患者氧氟沙星耐药率为12.3%，复治肺结核患者为46.0%,差异有统计学意义（χ²=31.16, P<0.01）；首次复治患者氧氟沙星耐药率为41.7%，其他复治患者为49.0%，差异无统计学意义（χ²=0.46, P=0.50）；耐多药组氧氟沙星耐药率为57.8％，多耐药组为35.1％，单耐药组为6.3％，一线药物敏感组为5.2％，其中耐多药组与其他3组、多耐药组与一线药物敏感组的耐药率差异有统计学意义（χ²=6.04、10.52、59.87、17.97，P均<0.05）；青年组氧氟沙星耐药率29.5％，中年组为26.5％，老年组为14.0％, 老年组与青年组的耐药率差异有统计学意义（χ²=5.10, P=0.02）；原发性氧氟沙星耐药率9.9％，继发性氧氟沙星耐药率78.4％, 差异有统计学意义（χ²=96.47, P<0.01）。结论耐多药肺结核氧氟沙星耐药率明显高于其他耐药类型的肺结核。结核菌对氧氟沙星的继发耐药率明显高于原发耐药率。氧氟沙星的不恰当应用极易导致氧氟沙星的耐药。

关键词: 结核, 肺/药物疗法, 分枝杆菌, 结核, 氧氟沙星, 抗药性, 细菌

Abstract: ObjectiveTo investigate the resistant situation of Ofloxacin to mycobacterium tuberculosis isolated from sputum of patients with pulmonary tuberculosis and to provide scientific evidence for utilizing Ofloxacin in antituberculosis regimen. MethodsAll strains isolated from patients hospitalized in Shanghai Pulmonary Hospital Affiliated Tongji University from August 2007 to March 2008 were conducted to strain identification and drug susceptibility tests with Ofloxacin, Isoniazid, Rifampin, Streptomycin and Ethambutol. ResultsThe total Ofloxacin resistant rate was 24.9% among 233 mycobacterium tuberculosis strains, lower than those of the first-line drugs. The difference of Ofloxacin resistant rates between in the initial treatment group (12.3%) and in the retreatment group (46.0%) were significant statistically (χ²=31.16,P<0.01), but there was no statistically significant difference about the Ofloxacin resistant rates between in the first-time retreatment group (41.7%) and in the other retreatment group (49.0%) (χ²=0.46,P=0.50). The Ofloxacin resistant rates were 57.8% in the multi-drug resistant (MDR) group, 35.1% in the poly-drug resistant (PDR) group, 6.3% in the single-drug resistant group, and 5.2% in the first-line drug susceptible group. The difference of resistant rates between the multi-drug resistant group and the other three groups was significant statistically（χ²=6.04、10.52、59.87, all P<0.05）, the difference of resistant rates between the poly-drug resistant group and the first-line drug susceptible group was also significant statistically(χ²=17.97，P<0.05）. The rates of Ofloxacin resistance in the youth group, the middle age group and the elder group were 24.5%, 26.5%, and 14.0%,respectively. There was statistically significant difference between the youth group and the elder group (χ²=2.741,P>0.05). Primary Ofloxacin resistant rate was 9.9％ and secondary Ofloxacin resistant rate was 78.4％ with significant difference（χ²=96.47, P<0.01）. ConclusionsThe Ofloxacin resistance rate in the MDR group was much higher than that of in the other groups. The secondary Ofloxacin resistant rate was much higher than that of the primary Ofloxacin resistant rate. Unreasonable utilization of Ofloxacin can easily lead to its resistance.

Key words: Tuberculosis,pulmonary/drug therapy, Mycobacterium tuberculosis, Ofloxacin, Drug resistance,bacterial

闫丽萍,肖和平. 住院肺结核患者耐氧氟沙星情况分析[J]. 中国防痨杂志, 2009, 31(8): 477-480.

Yan Liping, Xiao Heping. Clinical monitor and analysis on Ofloxacin resistance of pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2009, 31(8): 477-480.

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