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中国防痨杂志 ›› 2013, Vol. 35 ›› Issue (10): 831-834.

• 论著 • 上一篇    下一篇

中国耐多药结核分枝杆菌二线抗结核药物敏感性分析

赵冰 宋媛媛 逄宇 李强 欧喜超 夏辉 赵雁林   

  1. 102206 北京，中国疾病预防控制中心结核病预防控制中心
  • 收稿日期:2013-07-13 出版日期:2013-10-10 发布日期:2014-01-03
  • 通信作者: 赵雁林 E-mail:zhaoyanlin@chinatb.org
  • 基金资助:

    中国卫生部与比尔及梅琳达·盖茨基金会结核病防治项目（2009-04-01）

Analysis of drug susceptibility profiles of multidrug-resistant M. tuberculosis isolated from China

ZHAO Bing, SONG Yuan-yuan, PANG Yu, LI Qiang, OU Xi-chao, XIA Hui, ZHAO Yan-lin   

  1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2013-07-13 Online:2013-10-10 Published:2014-01-03
  • Contact: ZHAO Yan-lin E-mail:zhaoyanlin@chinatb.org

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摘要： 目的 分析中国耐多药结核分枝杆菌（MDR-TB）菌株对二线抗结核药物的敏感性，为耐多药结核病防治政策的制定提供科学依据。方法 从全国2007—2008年耐药基线调查收集的菌株中选取2008年4—7月期间耐药基线调查点收集的126株MDR菌株，对其进行2种一线抗结核药物（链霉素和乙胺丁醇）和7种二线抗结核药物（氧氟沙星、卡那霉素、卷曲霉素、乙硫异烟胺、丙硫异烟胺、环丝氨酸和对氨基水杨酸）的敏感性进行检测，分析对不同药物耐药率以及交叉耐药的情况。结果 一线药物链霉素和乙胺丁醇，总体耐药率分别为73.0%（92/126）和58.7%（74/126）；对于二线药物，氧氟沙星和乙硫异烟胺耐药率最高，分别为25.4%（32/126）和23.0%（29/126）；其次为卡那霉素和环丝氨酸，其耐药率分别为17.5%（22/126）和13.5%（17/126）；最后为卷曲霉素、丙硫异烟胺和对氨基水杨酸，其耐药率均为3.2%（4/126）。初治患者对卡那霉素（χ2=20.025，P<0.01）和环丝氨酸（χ2=6.558，P=0.017）的耐药率(卡那霉素: 20/60, 33.3%; 环丝氨酸: 13/60,21.7%)显著高于复治患者(卡那霉素: 2/66, 3.0%; 环丝氨酸: 4/66,6.1%)。此外，卡那霉素和卷曲霉素，乙硫异烟胺和丙硫异烟胺间均存在单向交叉耐药，在对卷曲霉素耐药的4株中，有3株同时对卡那霉素耐药；4株对丙硫异烟胺耐药菌株均同时对乙硫异烟胺耐药。结论 我国耐多药结核分枝杆菌菌株对二线抗结核药物具有较高的耐药率，特别是氧氟沙星和乙硫异烟胺，这对我国结核病控制工作，特别是耐多药结核病控制工作的实施带来严峻的挑战。

关键词: 枝杆菌, 结核, 抗药性, 多种, 细菌, 抗生素类, 抗结核, 微生物敏感性试验

Abstract: Objective To analyze drug susceptibility profiles of multi-drug resistant (MDR) M. tuberculosis isolated from China, and provide the scientific evidence for MDR-tuberculosis (MDR-TB) control and prevention. Methods One hundred and twenty-six MDR isolates were selected from the first drug resistant survey in China between April 2008 and July 2008. The conventional drug susceptibility testing was used to detect the drug-resistant profiles against 2 first-line (streptomycin and ethambuol) and 7 second-line anti-tuberculosis drugs (ofloxacin, kanamycin, capreomycin, ethionamide, protionamide，cycloserine and 4-Amino-2-hydroxybenzoicacid). The drug-resistant proportion and cross resistance were analyzed. Results For first-line drugs, the drug-resistant proportions against streptomycin and ethambuol were 73.0% (92/126) and 58.7% (74/126), respectively. For second-line drugs, the percentages of the resistance to ofloxacin and ethionamide were the highest, accounting for 25.4% (32/126) and 23.0% (29/126), respectively. Then, 17.5% (22/126) and 13.5% (17/126) of MDR strains were resistant to kanamycin and cycloserine, respectively. In addition, the drug-resistant rates of capreomycin, protionamide and 4-Amino-2-hydroxybenzoicacid were all 3.2% (4/126). The drug-resistant proportions of kanamycin (χ2=20.025，P<0.01) and cysloserine (χ2=6.558，P=0.017) in new case group were significantly higher than that in re-treated case group. In addition, there were the cross-resistances between kanamycin and capreomycin, or ethionamide and protionamide. Three of four capreomycin-resistant isolates were resistant to kanamycin, and all four protionamide-resistant strains were resistant to ethionamide meanwhile. Conclusion The high prevalence of M. tuberculosis strains with the resistance to second-line anti-tuberculosis drugs, especially to ofloxacin and ethionamide in MDR-TB patients was the major challenge on the prevention and control of TB and MDR-TB in China.

Key words: Mycobacterium tuberculosis, Drug resistance, multiple, bacterial, Antibiotics, antitubercular, Microbial sensitivity tests

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