223例住院煤工尘肺肺结核患者耐药情况分析

中国防痨杂志 ›› 2013, Vol. 35 ›› Issue (10): 823-826.

223例住院煤工尘肺肺结核患者耐药情况分析

孔冬青陈东进张满刚李伟李梅玲

102308 北京京煤集团总医院尘肺与结核科

收稿日期:2013-05-11 出版日期:2013-10-10 发布日期:2014-01-03
通信作者: 孔冬青 E-mail:kongdq@sina.com

An analysis of the drug resistance situation of 223 inpatient coal workers of pneumoconiosis-tuberculosis

KONG Dong-qing, CHEN Dong-jin, ZHANG Man-gang, LI Wei, LI Mei-ling

Department of Pneumoconiosis and Tuberculosis, General Hospital of Beijing Jingmei Group, Beijing 102308, China

Received:2013-05-11 Online:2013-10-10 Published:2014-01-03
Contact: KONG Dong-qing E-mail:kongdq@sina.com

摘要/Abstract

摘要： 目的了解煤工尘肺肺结核患者耐抗结核药物情况，探寻其防治策略。方法收集2009年1月至2012年12月北京京煤集团总医院尘肺肺结核科住院并确诊的223例煤工尘肺肺结核患者临床资料，分析其耐药情况，采用描述性统计的方法，计数资料采用χ²检验，P＜0.05为差异有统计学意义。结果 223例患者抗结核药物总耐药率为42.60%（95/223），耐药患者中初治占26.32%（25/95）、复治占73.68%（70/95），二者比较差异有统计学意义（χ²=58.436，P＜0.01）；多耐药率为50.53%（48/95）、耐多药率为34.74%（33/95）、广泛耐药率为7.37%（7/95）；在检测的抗结核药物中，耐一线抗结核药物依次为H 73.68%（70/95）、S 70.53%（67/95）、R 64.21%（61/95）、E 50.53%（48/95），耐二线抗结核药物前4位依次是Km 44.21%（42/95）、PAS 36.84%（35/95）、Ofx 35.79%（34/95）、Pto 24.21%（23/95）；初治患者对一线抗结核药物耐药顺位是S>H>R>E［耐药率分别为76.00%(19/25)、56.00%(14/25)、52.00%(13/25)、44.00%(11/25)］，对二线抗结核药物耐药主要是Km（48.00%,12/25）、Ofx（44.00%,11/25）；复治患者对一线抗结核药物耐药顺位是H>S>R>E>Z［耐药率分别为80.00%(56/70)、68.57%(48/70)、67.14%(47/70)、52.86%(37/70)、7.14%(5/70)］，对二线抗结核药物耐药前5位是Km>PAS>Ofx>Pto>Lfx［耐药率分别为42.86%(30/70)、40.00%(28/70)、32.86%(23/70)、25.71%(18/70)、15.71%(11/70)］，且耐药品种较初治患者明显增多。结论煤工尘肺肺结核住院患者耐药状况较严重，应加强其卫生管理、治疗方法的研究。

关键词: 煤肺病, 结核, 肺, 抗药性, 细菌

Abstract: Objective To understand the drug resistance situation of coal workers of pneumoconiosis-tuberculosis, and to explore the control strategy. Methods The clinical data of 223 coal workers lived in the General Hospital of Beijing Jingmei Group and diagnosed with pneumoconiosis-tuberculosis from January 2009 to December 2012 were collected and the drug resistance situation was analyzed. Descriptive statistics was employed andχ² test was applied to categorical data. P<0.05 was set to be the criteria of statistical significance. Results The overall drug resistance rate was 42.60% (95/223), among whom 26.32% (25/95) were new cases and 73.68% (70/95) were retreatment cases, and the difference was significant between the two types (χ²=58.436, P<0.01). The poly-resistance rate was 50.53% (48/95), the multidrug-resistance rate was 34.74% (33/95) and the extremely drug resistance rate was 7.37% (7/95). The mono-resistance rates of first-line drugs were 73.68% (70/95) for H, 70.53% (67/95) for S, 64.21% (61/95) for R, 50.53% (48/95) for E, and those of second-line drugs were 44.21% (42/95) for Km, 36.84% (35/95) for PAS, 35.79% (34/95) for Ofx and 24.21% (23/95) for Pto. The order of drug resistance rate of new cases to first-line drugs in descending order was S>H>R>E, and the drug resistance rates were 76.00% (19/25), 56.00% (14/25), 52.00% (13/25) and 44.00% (11/25) respectively. Km (48.00%, 12/25) and Ofx (44.00%, 11/25) were the main second-line drugs to which that new cases were resistant. The order of drug resistance rate of retreatment cases to first-line drugs in descending order was H>S>R>E>Z, and the drug resistance rates were 80.00% (56/70), 68.57% (48/70), 67.14% (47/70), 52.86% (37/70) and 7.14%(5/70) respectively. The order to second-line drugs were Km>PAS>Ofx>Pto>Lfx, and the rates were 42.86% (30/70), 40.00% (28/70), 32.86% (23/70), 25.71% (18/70) and 15.71% (11/70), and the number of resistant drugs was significantly higher than new cases. Conclusion The drug resistance of inpatient coal workers of pneumoconiosis-tuberculosis is serious. The study on management and treatment methods should be strengthened to improve the situation.

Key words: Anthracosis, Tuberculosis, pulmonary, Drug resistance, bacterial

孔冬青陈东进张满刚李伟李梅玲. 223例住院煤工尘肺肺结核患者耐药情况分析[J]. 中国防痨杂志, 2013, 35(10): 823-826.

KONG Dong-qing, CHEN Dong-jin, ZHANG Man-gang, LI Wei, LI Mei-ling. An analysis of the drug resistance situation of 223 inpatient coal workers of pneumoconiosis-tuberculosis[J]. Chinese Journal of Antituberculosis, 2013, 35(10): 823-826.