【摘要】 目的了解浙江省温州市分枝杆菌耐药状况,为制定耐药结核病控制策略提供依据。方法随机抽取温州市3县(市)作为耐药监测点,选取监测点2008年和2013年新发和复治涂阳肺结核患者分枝杆菌分离株196株进行4种一线抗结核药物[异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)]的耐药性测定;对耐多药(MDR)菌株进行9种二线抗结核药物[卡那霉素(KM)、阿米卡星(AM)、卷曲霉素(CPM)、对氨基水杨酸(PAS)、丙硫异烟胺(PTO)、环丝氨酸(CS)、氧氟沙星(Of X)、左氧氟沙星(LVFX)、莫西沙星(MOX)]的耐药性测定。结果在196株分枝杆菌中,结核分枝杆菌191株。总耐药率为25.1%(48/191),其中新涂阳和复治涂阳耐药率分别为21.9%(36/164)和44.4%(12/27),差异有统计学意义(χ2=6.23,P<0.05);MDR率为6.8%(13/191),其中新涂阳和复治涂阳MDR率分别为4.3%(7/164)和22.2%(6/27),差异有统计学意义(χ2=9.12,P<0.01);4种一线抗结核药物的耐药率由高到低依次为S(19.9%)、H(14.7%)、R(7.9%)、E(3.1%);耐1、2、3和4种药物的耐药率分别为14.7%、5.2%、2.6%和2.6%;男性与女性的耐药率和MDR率分别为25.5%(36/141)、6.4%(9/141)和24.0%(12/50)、8.0%(4/50),差异无统计学意义(χ2分别为0.05和0.93,均P>0.05);不同年龄组间耐药率差异无统计学意义(χ2=5.34,P>0.05);MDR菌株二线抗结核药物耐药率达8/13;二线抗结核药物的耐药率由高到低依次为OFX和PAS(均为5/13)、CS(4/13)、LVFX和MOX(均为1/4)、CPM(1/13)。结论温州市耐多药结核病疫情较严重,而且对二线抗结核药物具有较高的耐药率,建议开展二线抗结核药物敏感性检测,加强耐药结核病患者的发现和治疗管理工作。更多还原

【Abstract】 Objective To understand the prevalence of drug-resistant Mycobacterium(M.) tuberculosis in Wenzhou,Zhejiang province,and provide evidence for the prevention and control of drug-resistant tuberculosis(TB).Methods The susceptibility tests of 196 M.tuberculosis strains isolated from smear positive TB patients to four first line anti-TB drugs(isoniazid,rifampicin,streptomycin and ethambutol) and nine second-line anti-TB drugs(kanamycin,amikacin,capreomycin,p-aminosalicylic acid,protionamide,cyclocerine,ofloxacin,levofloxacin,moxifloxacin) were performed.Results A total of 191 M.tuberculosis strains were cultured.The overall drug-resistant rate was 25.1%(48/191); the initial drug-resistant rate was 21.9%(36/164) and the acquired drug-resistant rate was 44.4%(12/27),the difference was significant(χ2= 6.23,P < 0.05).The multidrugresistant(MDR) rate was 6.8%(13/191),in which the initial and the acquired MDR rates were 4.3%(7/164) and 22.2%(6/27),respectively,the difference was significant(χ2= 9.12,P < 0.01).The resistant rates to streptomycin,isoniazid,rifampicin and ethambutol were 19.9%,14.7%,7.9% and3.1%,respectively.The resistant rates to one,two,three and four first line anti TB drugs were 14.7%,5.2%,2.6% and2.6%,respectively.The overall drugresistant rate and MDR rate were 25.5%(36/141) and 6.4%(9/141),respectively,in males and 24.0%(12/50) and 8.0%(4/50) in females,the differences were not significant(χ2= 0.05,χ2= 0.93,allP > 0.05).The age specific overall drug resistant rate showed no significant differences(χ2= 5.34,P > 0.05).In 13 MDR strains,8(61.5%) showed resistance to at least one secondline anti-TB drugs tested.For second line anti-TB drugs,the resistant rate to ofloxacin and p-aminosalicylic acid was highest(5/13),followed by that to cyclocerine(4/13),that to levofloxacin,moxifloxacin(1/4) and that to capreomycin(1/13).Conclusion The prevalence of MDR-TB was high in Wenzhou,it is necessary to strengthen the prevention and control of drugresistant TB by conducting the susceptibility test to the second line anti-TB drugs and improving the detection and treatment of drug resistant TB patients更多还原