武汉市涂阳肺结核患者耐药率及耐药谱分析

摘要/Abstract

摘要： 目的分析不同登记分类涂阳肺结核患者的耐药［特别是耐多药结核病（MDR-TB）］特点，了解耐药的危险因素，为制订耐药结核病（特别是MDR-TB）控制策略提供参考。方法对痰涂片阳性的新患者、复治（复发、返回和其他）和治疗失败（初治失败、复治失败和治疗3个月末痰涂片阳性的新患者）3类患者收集2份痰标本进行培养，用比例法进行6种抗结核药物（INH、RFP、EMB、S、Km和Ofx）敏感性试验。2006年12月至2012年3月进行痰培养的涂阳肺结核患者2110例，培养阳性1947例（92.3%）；经药物敏感性试验和菌型鉴定，Mtb感染1800例（92.4%）。结果 1800例Mtb感染者中总耐药794例（44.1%，794/1800），其中单耐药结核病（SDR-TB） 244例（13.6%, 244/1800）、多耐药结核病（PDR-TB）155例（8.6%,155/1800）、MDR-TB 395例（21.9%,395/1800）；MDR-TB检出率明显高于SDR-TB和PDR-TB（χ²=43.4，χ²=123.6，P值均＜0.01）。新患者、复治及治疗失败3类患者SDR-TB检出率分别为11.9%（57/480）、14.4%（159/1107）及13.1%（28/213），差异无统计学意义（χ²=0.33，P=0.85）；3类患者PDR-TB检出率分别为5.4%（26/480）、9.8%（109/1107）及9.4%（20/213）,复治与治疗失败PDR-TB检出率差异无统计学意义（χ²=0.04，P=0.84），但高于新患者（χ²=8.53，P=0.01）；3类患者MDR-TB检出率分别为14.4%（69/480）、22.5%（249/1107）及36.2%（77/213），经χ²检验，治疗失败患者MDR-TB检出率高于复治和新患者（χ²=17.92，χ²=42.07，P值均＜0.01）。结论武汉市涂阳肺结核患者耐药检出率高；耐药成因复杂，耐药谱呈多样性和复杂性，对结核病控制构成威胁。

关键词: 结核, 肺/药物疗法, 抗药性, 细菌, 武汉市

Abstract: Objective To analyze the resistance characteristics of different registration classification smear positive TB patients (especially MDR-TB) and to understand the risk factors in order to provide reliable references for development of drug-resistant TB control strategy. Methods Two sputum samples were collected from each smear positive patient in 3 categories-new, re-treatment (relapse, transfer in and others) and treatment failure (failure of new patient, retreatment patient and new patients who remain smear positive after 3 months of treatment) for sputum culture by proportional method, six kinds of anti-TB drugs (INH, RFP, EMB, S, Km, Ofx) were tested for susceptibility. Between December 2006 and March 2012, a total of 2110 cases of smear positive TB patients were sputum cultured, in which 1947 cases (92.3%) were culture positive; through drug susceptibility test (DST) and bacterial typing, 1800 cases of Mtb (92.4%) were identified eventually. Results Among the 1800 Mtb cases, a total of 794 cases (44.1%，794/1800) were identified as drug-resistant TB, out of which, 244 cases (13.6%,244/1800) were single-drug-resistant (SDR) TB, 155 cases (8.6%,155/1800) were poly-drug-resistant (PDR) TB, 395 cases (21.9%,395/1800) were MDR-TB, the detection rate of MDR-TB is significantly higher than SDR-TB and PDR-TB (χ²=43.4, χ²=123.6，P＜0.01).The detection rate of SDR for new, re-treatment and treatment failure TB patients was 11.9%(57/480), 14.4%(159/1107)and 13.1%(28/213) respectively, the difference is not statistically significant (χ²=0.33, P=0.85); the detection rate of PDR for new, re-treatment and treatment failure TB patients was 5.4%(26/480), 9.8%(109/1107) and 9.4%(20/213) respectively, the difference is not statistically significant between retreatment and treatment failure cases (χ²=0.04, P=0.84). however, they are higher than that of new TB cases (χ²=8.53, P=0.01); the detection rate of MDR for new, re-treatment and treatment failure TB patients was 14.4%(69/480)，22.5%(249/1107) and 36.2%(77/213)respectively, the detection rate of treatment failure TB patients is higher than that of new and re-treatment TB patients (χ²=17.92, χ²=42.07, P＜0.01). Conclusion The detection rate of drug resistant TB is high among smear positive TB patients in Wuhan. The diversity and complexity of drug resistant spectrum poses a threat to TB control in China.

Key words: Tuberculosis, Pulmonary/drug therapy, Drug resistance, bacterial, Wuhan city

周美兰陈梓王坚杰陈聪潘宏焦新光. 武汉市涂阳肺结核患者耐药率及耐药谱分析[J]. 中国防痨杂志, 2013, 35(2): 97-102.

ZHOU Mei-lan, CHEN Zi, WANG Jian-jie, CHEN Cong, PAN Hong, JIAO Xin-guang. Analysis of the drug resistance patterns and resistance rates among smear positive TB patients in Wuhan city[J]. Chinese Journal of Antituberculosis, 2013, 35(2): 97-102.

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