【摘要】 目的 分析老年肺结核患者抗结核药物敏感性的特点，为老年肺结核的临床治疗提供参考。方法 回顾性随机选取2019年1月至2021年3月北京老年医院收治的肺结核患者270例，按照年龄分为低龄老年组（60～<80岁）、高龄老年组（≥80岁）、非老年组（<60岁）各90例。比较分析三组患者的临床特征、抗结核药物敏感性、抗结核药物耐药率及耐药类型。结果 三组患者男性比例均高于女性，性别构成差异无显著性，初治患者比例均高于复治患者。初治患者中，高龄老年组对帕司烟肼的耐药率明显低于其他两组，对异烟肼、链霉素、利福平、利福喷丁、利福布汀的耐药率明显低于非老年组，低龄老年组对利福平、利福喷丁、利福布汀的耐药率明显低于非老年组，差异均有显著性（P<0.05）。低龄老年组与高龄老年组利福平耐药结核病患者比例、总耐药肺结核病总数均明显低于非老年组，全敏感肺结核病总数均明显高于非老年组，而高龄老年组单耐药结核病、耐多药结核病患者比例明显低于非老年组，差异均有显著性（P<0.05）。复治患者中，高龄老年组对帕司烟肼、链霉素、利福平、利福喷丁的耐药率明显低于其他两组，对左氧氟沙星、莫西沙星的耐药率明显低于非老年组，对利福布汀的耐药率明显低于低龄老年组，低龄老年组对氯法齐明的耐药率明显低于非老年组，高龄老年组中利福平耐药结核病患者比例、总耐药肺结核病总数明显低于其他两组，全敏感肺结核病总数明显高于其他两组，差异均有显著性（P<0.05）。结论 老年肺结核患者对多种抗结核药物的耐药率较低，高龄老年患者对异烟肼、利福平等一线药物的耐药率低，耐多药结核病、利福平耐药结核病的比例较低，临床需根据患者具体情况选择个体化抗结核治疗方案，同时，应持续加强肺结核患者的耐药监测及管理，减少耐药结核病的产生及传播。更多还原

【Abstract】 Objective To analyze the characteristics of anti-tuberculosis drug sensitivity in elderly pulmonary tuberculosis(PTB) patients,so as to provide reference for clinical treatment of PTB among elderly people. Method A total of 270 patients with PTB admitted to Beijing Geriatric Hospital from January 2019 to March 2021 were retrospectively randomly selected, including the junior elder group(60—<80 years old), the elderly group(≥80 years old), and the non-elderly group(<60 years old), 90 cases in each group. The clinical characteristics, anti-tuberculosis drug sensitivity, anti-tuberculosis drug resistance rate and drug resistance types of the three groups were compared and analyzed. Result Among the three groups, the proportion of male patients was higher than that of female patients, and the proportion of initial treated patients was higher than that of retreated patients. There was no significant difference in gender composition among the three groups(P>0.05). Among the initial treatment patients, the drug resistance rate of isoniazid, streptomycin, rifampicin,rifapentine, rifabutin and the proportion of mono-resistant tuberculosis(MR-TB), multidrug-resistant tuberculosis(MDR-TB) in the elderly group were significantly lower than that in the non-elderly group, and the drug resistance rate of parisoniazid was significantly lower than that in the other two groups(P<0.05). The drug resistance rate of rifampicin, rifapentine and rifabutin in the junior elderly group was significantly lower than that in the non-elderly group(P<0.05). The proportion of rifampicin-resistant tuberculosis(RR-TB) and total resistant tuberculosis in the two elderly groups was significantly lower than that in the non-elderly group(P<0.05). Among the treated patients, in the elderly group the drug resistance rate of rifampicin, streptomycin, rifapentine and parisoniazid and the proportion of RRTB and total resistant tuberculosis were significantly lower than those in the other two groups, the drug resistance rate of levofloxacin and moxifloxacin was significantly lower than that in the non-elderly group, and the drug resistance rate to rifabutin was significantly lower than that in the junior elderly group(P<0.05). The resistance rate to clofazimine in the junior elderly group was significantly lower than that in non-elderly group(P<0.05). Conclusion The resistance rate of multi anti-tuberculosis drugs is low in the elderly PTB patients. The resistance rate of first-line drugs such as isoniazid and rifampicin is low in elderly PTB patients, and the proportion of MDR-TB and RR-TB is low. Clinical treatment should be individualized according to the specific conditions of the elderly patients. At the same time, the surveillance and management of drug resistance should be continuously strengthened to reduce the occurrence and spread of drug-resistant tuberculosis.更多还原