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中国防痨杂志 ›› 2010, Vol. 32 ›› Issue (6): 24-28.

• 论著 • 上一篇    下一篇

深圳市可疑耐多药病人中的耐药结核病及其耐药谱分布特点

许丽, 杨应周, 吴清芳, 李明珍, 张玉华, 管红云   

  1. 深圳市慢性病防治中心,深圳,518020
  • 出版日期:2010-06-20 发布日期:2010-06-20
  • 基金资助:

    深圳市科技计划项目(200902094); 国家十一五科技重大专项:《结核病发病模式研究》(2008ZX10003-007)

Analysis on situation and pattern of drug resistance tuberculosis in suspected multi-drug resistance patients in Shenzhen

Xu Li; Yang Yingzhou; Li Mingzhen; Wu Qingfang; Zhuang Yuhua; Guan Hongyun   

  1. Shenzhen Center for Chronic Disease Control; Shenzhen 518020; China;
  • Online:2010-06-20 Published:2010-06-20
  • Contact: Xu Li E-mail:bluesunxl@hotmail.com

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摘要： 目的 研究耐药结核病（DR-TB）在不同类型可疑耐多药结核病人（MDR-TB）中的分布特点及其耐药谱分布情况，为制定MDR-TB控制策略提供科学依据。 方法 2006年10月—2009年4月深圳市发现的可疑耐多药结核病人为研究对象，通过痰涂片、培养、菌种鉴定和药物敏感试验诊断MDR-TB，按照可疑MDR-TB患者不同肺结核类型发生耐药和耐多药结核病情况进行统计分析。结果406例临床分离菌株做药物敏感试验，其中36.2%为MDR-TB，18.9% 为其他DR-TB；82例初治可疑MDR-TB患者中，MDR-TB占45.1%；310例复治可疑MDR-TB患者中，MDR-TB占33.2%，以复治失败所占比例最高，为66.7%。147例MDR-TB病例中，初治占28.6%，复治70.1%，新患者1.3%。77例其他DR-TB病例中，初治占22.1%，复治77.9%。初治组2类病例均有较高的MDR-TB和DR-TB发生率；复治组中复治失败病例的MDR-TB发生率最高。MDR-TB中，初治组以耐HRS和HRES为多，复治组以HR和HRES为多；MDR-TB外的其他DR-TB患者中，各耐药谱的耐药频率以单耐药为主，其中耐H或R的频度最高。 结论 复治组是MDR-TB发生的主要类别，但3个月末涂阳和初治失败患者也存在较高的MDR-TB发生率(实际上此病例已属复治)；初、复治组MDR-TB均有较严重的耐药程度，其他DR-TB为发生MDR-TB的高危人群。

关键词: 结核, 肺/药物疗法, 抗药性, 细菌, 深圳市

Abstract: Objective To investigate the distribution characteristics and pattern of DR-TB in different types of suspected pulmonary MDR-TB patients and provide scientific evidence for MDR-TB control in Shenzhen. Methods All suspected MDR-TB found during October 2006 to April 2009 were investigated. Sputum smear, culture, bacterial identification and drug susceptibility test were performed for diagnosis of MDR-TB. Statistical analysis was made for the incidence rate of DR-TB and MDR-TB in different types of pulmonary MDR-TB patients. Results 406 isolated strains ofMycobacterium tuberculosiswere tested for drug susceptibility, 36.2% of them were diagnosed as MDR-TB; MDR-TB accounted for 45.1% and 33.2% respectively in 82 cases of initial and 310 cases of retreatment suspected MDR-TB cases. In the category of retreatment failure, the proportion of MDR-TB is the highest of 66.7%. Among 147 cases of MDR-TB, initial treatment, retreatment and new patients accounted for 28.6%, 70.1% and 1.3% respectively. Of the 77 cases of other DR-TB, initial and retreatment PTB accounts for 22.1% and 77.9% respectively. The MDR-TB and DR-TB proportion are both high in two categories under initial treatment group. MDR-TB constituted the highest portion in retreatment failure category under retreatment group. In MDR-TB cases, the highest frequency is resistance to HRS and HRES in initial treatment group and HR and HRES in retreatment group. For other DR-TB patients, the majority is single drug resistance with highest frequency in H and R resistance.  Conclusion s Retreatment group was the major category for MDR-TB occurrence, however, there are also high MDR-TB incidence in those with smear positive Results after 3 months treatment and those with initial treatment failure(in fact, these are already retreatment cases). Drug resistance is serious in both new and retreatment group. And other DR-TB is high risk population for MDR-TB.

Key words: tuberculosis, pulmonary/drug therapy, drug resistance, bacterial, Shenzhen city

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