【作者】 刘一典； 唐神结； 张青； 景玲杰； 韩敏； 乐军；

【Author】 Shanghai Pulmonary Hospital Affiliated to Tongji University,Shanghai,200433,China LIU Yi-dian,ZHANG Qing,JING Ling-jie,HAN Min,YUE Jun

【机构】 上海市肺科医院结核科；

【摘要】 目的了解近来结核分枝杆菌株对一线和二线抗结核药物的耐药模式。方法收集2008年1月至2009年3月我院使用Bactec-MGIT 960检测的518株结核分枝杆菌药敏结果进行分析。结果 518株结核分枝杆菌菌株,全敏感168株(32.44%);耐药350株(67.56%)。单耐药72株(13.90%),耐2药24株(4.63%),耐3种及以上254株(49.03%),耐多药为217株(41.89%),广泛耐药为65株(12.55%),早期广泛耐药为106株(20.46%)。在一线药物中异烟肼的耐药率最高达53.67(278株)。二线药物中氧氟沙星耐药最高达39.77%(206株)。在321株对一种及以上的一线药物的耐药菌株中,对Ofx的耐药率高达57.01%(183株),对Am的耐药率为25.55%(82株),对Cm的耐药率为33.02%(106株)。217株MDR菌株中,对Ofx耐药157株,耐药率高达72.35%。在518株中,对S耐药238株(45.95%),对Am耐药82株(15.83%),对Cm耐药113株(21.81%),对S、Am和Cm同时耐药65株(12.55%)。对S耐药的238株中,对Am和Cm的耐药率仅分别为31.51%和38.66%(χ2=2.666,p=0.103)。对Am耐药的82株中对Cm耐药72株(87.80%),对Cm耐药113株中对Am耐药72株(63.72%),两者相比差异有显著统计学意义(χ~2=14.276,p<0.001)。结论目前,结核分枝杆菌耐药率高,且耐药情况严重,更多的耐药菌株表现为更严重的耐药类型。氧氟沙星耐药率高,耐多药中氧氟沙星耐药率更高,应加强氟喹诺酮类药物的管理。注射类抗结核药物中,链霉素耐药率最高,且耐链霉素菌株大多对阿米卡星和卷曲霉素敏感,阿米卡星和卷曲霉素之间呈现较高的交叉耐药性。更多还原

【Abstract】 Objective To investigate recently resistant patterns of Mycobacterium tuberculosis strains to first-and second-line anti-TB drugs.Method Drug susceptibility tests of 518 MTB strains were performed using Bactec-MGIT 960 from January 2008 to March 2009.The results were collected and analyzed.Results In 518 strains,168(32.43%) were sensitive to all seven drugs;350(67.56%) were resistant to at least one drug; 72(13.90%) were resistant to one drug;24(4.63%) were resistant to two drugs;254(49.03%) were resistant to three or more drugs.MDR were confirmed in 217 strains(41.89%),XDR in 65 strains(12.55%) and pre-XDR in 106 strains(20.46%).The drug resistant rate of isoniazid was the highest in the first-line drugs which reached 53.67%(278 strains).In second-line drugs,the drug resistant rate of ofloxacin was the highest which reached 39.77%(206 strains).In 321 strains which were resistant to one or more first-line drugs,57.01%(183 strains) were resistant to ofloxacin,25.55%(82 strains) were resistant to amikacin,33.02%(106 strains) were resistant to capreomycin.In 217 MDR strains,157strains(72.35%) resisted ofloxacin.In 518 strains,238 strains(45.95%) were resistant to streptomycin,82 strains(15.83%) resistant to amikacin,113 strains(21.81%) resistant to capreomycin,65 strains(12.55%) resistant to streptomycin,amikacin and capreomycin at the same time.In 238 strains resistant to streptomycin,the resistant rates of amikacin and capreomycin were 31.51%and 38.66%,repectively(χ~2=2.666,p=0.103).In 82 strains resistant to amikacin,72 strains(87.80%) were also resistant to capreomycin.In 113 strains resistant to capreomycin,72 strains(87.80%) were also resistant to amikacin (63.72%).The difference was statistically significant(χ~2=14.276,p<0.001).Conclusion Currently,the resistant rate of MTB is high and in serious condition.More of the resistant strains showed more serious resistant patterns.The resistant rate of ofloxacin was high;and it was even higher in MDR-TB.We should strengthen the management of quinolones.Among injectable anti-TB drugs,the resistant rate of streptomycin was the highest, and most streptomycin-resistant strains were sensitive to amikacin and capreomycin.Amikacin and capreomycin exhibited high cross-resistance.更多还原