青海省南部地区154株结核分枝杆菌临床分离株耐药性检测结果分析

doi:10.3969/j.issn.1000-6621.2020.12.007

摘要/Abstract

摘要：

目的了解青海省南部地区(以下简称“青南地区”)结核分枝杆菌的耐药现状与特征,并获得青南地区耐药谱,为预防和控制青南地区耐药结核病的流行提供参考依据。方法收集青南地区(玉树州、果洛州、黄南州)市/州级疾病预防控制中心结核病实验室2018—2019年全部518例病原学阳性患者标本,进行分离培养,并对培养阳性菌株进行抗结核药物敏感性试验和菌种鉴定,最终经菌种鉴定的结核分枝杆菌菌株为154株。对上述菌株进行6种常用抗结核药品 (异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星)的敏感性试验,并对上述菌株的耐药性检测结果进行统计分析。结果154株结核分枝杆菌总耐药率为37.01%(57/154),单耐药率为23.38%(36/154),多耐药率为3.25%(5/154),耐多药率为10.39%(16/154),利福平耐药率为18.18%(28/154)。复治患者总耐药率为64.52%(20/31),耐多药率为35.48%(11/31),利福平耐药率为38.71%(12/31),均明显高于初治患者[分别为30.08%(37/123)、4.07%(5/123)、13.01%(16/123)],差异均有统计学意义(χ²=123.00,P<0.05;χ²=11.68,P<0.01;χ²=24.07,P<0.01)。男性总耐药率为37.89%(36/95),高于女性的35.59%(21/59),差异有统计学意义(χ²=57.00,P<0.01);45~<60岁年龄组总耐药率为50.00%(7/14),高于<45岁年龄组[37.50%(48/128)]和≥60岁年龄组[16.67%(2/12)],差异有统计学意义(χ²=118.51,P<0.01);学生总耐药率为47.22%(17/36),高于农民[34.38%(11/32)]、牧民[33.93%(19/56)]、其他职业[33.33%(10/30)],差异有统计学意义(χ²=371.17,P<0.01)。结论青南地区结核分枝杆菌对6种常用抗结核药品的耐药率较高,应加强对中青年、学校、农牧民等重点人群的耐药性监测与治疗。

关键词: 分枝杆菌,结核, 微生物敏感性试验, 结核,抗多种药物性, 数据说明,统计, 小地区分析

Abstract:

Objective To understand the present situation and characteristics of Mycobacterium tuberculosis (MTB) drug resistance and to obtain the drug resistant spectrum of southern Qinghai Province, so as to provide reference for the prevention and control of the epidemic of drug-resistant tuberculosis in southern Qinghai. Methods One hundred and fifty-four strains were identified as MTB from 518 pulmonary tuberculosis patients with positive etiology who were detected in the south of Qinghai (Yushu Prefecture, Guoluo Prefecture, Huangnan Prefecture) from 2018 to 2019. The drug susceptibility tests of the above strains to 6 commonly used anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin) were carried out, and the drug resistance results were statistically analyzed. Results The overall drug resistant rate of the 154 MTB strains was 37.01% (57/154).The mono-resistant rate, poly-resistant rate and multi-drug resistant rate and rifampicin resistant rate were 23.38% (36/154), 3.25% (5/154), 10.39% (16/154) and 18.18% (28/154) respectively. The overall drug resistant rate (64.52% (20/31)), multi-drug resistant rate (35.48% (11/31)) and rifampicin resistance rate (38.71% (12/31)) among retreated patients were significantly higher than those among new patients (30.08% (37/123), 4.07% (5/123), 13.01% (16/123)) (χ ²=123.00, P<0.05; χ ²=11.68, P<0.01; χ ²=24.07, P<0.01). The drug resistant rate of male (37.89% (36/95)) was significantly higher than that of female (35.59% (21/59)) (χ ²=57.00, P<0.01), and the overall drug resistant rate of middle-aged (45-<60 years old) group (50.00% (7/14)) was significantly higher than that of youth (<45 years old) group (37.50% (48/128)) and elderly (≥60 years old) group (16.67% (2/12)) (χ ²=118.51, P<0.01). The overall drug resistant rate of students (47.22% (17/36)) was significantly higher than that of farmers (34.38% (11/32)), herdsmen (33.93% (19/56)) and other occupations (33.33% (10/30))(χ ²=371.17, P<0.01). Conclusion The drug resistance rates of MTB strains to 6 commonly used anti-tuberculosis drugs are high in the southern area of Qinghai, and it is necessary to strengthen the drug resistance surveillance and treatment to the young and middle-aged groups, students, farmers and herdsmen and other key groups.

Key words: Mycobacterium tuberculosis, Microbial susceptibility tests, Tuberculosis,multi-drug resistant, Data interpretation,statistical, Small-area analysis

蒋明霞, 晁秀珍, 王兆芬, 马斌忠, 马永成, 王蓉, 王朝才, 李尔琛, 魏於家, 李咏雪, 张琪. 青海省南部地区154株结核分枝杆菌临床分离株耐药性检测结果分析[J]. 中国防痨杂志, 2020, 42(12): 1289-1293. doi: 10.3969/j.issn.1000-6621.2020.12.007

JIANG Ming-xia, CHAO Xiu-zhen, WANG Zhao-fen, MA Bin-zhong, MA Yong-cheng, WANG Rong, WANG Chao-cai, LI Er-chen, WEI Yu-jia, LI Yong-xue, ZHANG Qi. Drug resistance analysis of 154 Mycobacterium tuberculosis strains in southern Qinghai[J]. Chinese Journal of Antituberculosis, 2020, 42(12): 1289-1293. doi: 10.3969/j.issn.1000-6621.2020.12.007

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地区	MR-TB	PR-TB	MDR-TB	RR-TB	XDR-TB	TDR-TB
玉树州(44株)	6(13.64)	1(2.27)	3(6.82)	1(2.27)	0(0.00)	10(22.73)
果洛州(12株)	2(16.67)	0(0.00)	1(8.33)	4(33.33)	0(0.00)	3(25.00)
黄南州(98株)	28(28.57)	4(4.08)	12(12.24)	23(23.47)	0(0.00)	44(44.90)
合计(154株)	36(23.38)	5(3.25)	16(10.39)	28(18.18)	0(0.00)	57(37.01)
χ²值	72.00	5.00	22.49	27.15	-	7.21
P值	<0.05	<0.05	<0.05	<0.05	-	<0.05

患者分类	MR-TB	PR-TB	MDR-TB	RR-TB	XDR-TB	TDR-TB
初治(123株)	31(25.20)	1(0.81)	5(4.07)	16(13.01)	0(0.00)	37(30.08)
复治(31株)	5(16.13)	4(12.90)	11(35.48)	12(38.71)	0(0.00)	20(64.52)
合计(154株)	36(23.38)	5(3.25)	16(10.39)	28(18.18)	0(0.00)	57(37.01)
χ²值	28.12	5.00	11.68	24.07	-	123.00
P值	<0.01	>0.05	<0.01	<0.01	-	<0.05

社会学特征	例数	MR-TB	PR-TB	RR-TB	MDR-TB	TDR-TB	χ²值	P值
性别							57.00	<0.01
男	95	24(25.26)	4(4.21)	16(16.84)	8(8.42)	36(37.89)
女	59	12(20.34)	1(1.69)	12(20.34)	8(13.56)	21(35.59)
年龄(岁)							118.51	<0.01
<45	128	31(24.22)	5(3.91)	22(17.19)	12(9.38)	48(37.50)
45~	14	3(21.43)	0(0.00)	4(28.57)	2(14.29)	7(50.00)
60~79	12	2(16.67)	0(0.00)	2(16.67)	2(16.67)	2(16.67)
民族							288.37	<0.01
藏族	135	30(22.22)	5(3.70)	22(16.30)	11(8.15)	46(34.07)
蒙古族	14	4(28.57)	0(0.00)	2(14.29)	2(14.29)	6(42.86)
其他	5	2(2/5)	0(0/5)	4(4/5)	3(3/5)	5(5/5)
职业							371.17	<0.01
学生	36	14(38.89)	1(2.78)	7(19.44)	2(5.56)	17(47.22)
牧民	56	10(17.86)	2(3.57)	10(17.86)	7(12.50)	19(33.93)
农民	32	8(25.00)	1(3.13)	6(18.75)	2(6.25)	11(34.38)
其他	30	4(13.33)	1(3.33)	5(16.67)	5(16.67)	10(33.33)