【摘要】 目的评价首次复治及二次复治菌阳肺结核的耐药情况。方法采用前瞻性多中心研究,对首次及2次复治菌阳肺结核患者行痰罗氏结核分枝杆菌培养、药敏试验,对两组耐药类型、一线及二线抗结核药物耐药情况进行分析。结果二次复治患者抗结核药物总耐药率(67.9%)明显高于首次复治患者(40.5%),差异有统计学意义(P<0.05);二次复治患者单耐药率、耐多药率、耐左氧氟沙星(Lfx)率分别为25.6%、26.9%、14.3%,明显高于首次复治患者的耐药率(15.1%、16.6%、7.1%),差异有统计学意义(P均<0.05)。二次复治患者对异烟肼及利福平的耐药率分别为46.2%、39.7%,均显著高于首次复治病例(28.8%、19.2%),P均<0.05。结论二次复治肺结核患者耐药率较首次复治病例明显增加,耐多药肺结核发生率及对利福平、异烟肼的耐药率均明显提高,因此应重视首次复治肺结核患者的规范化治疗,减少复治次数,对复治患者应及时进行药敏试验,以指导临床用药。更多还原

【Abstract】 Objective To analyze the drug resistance in the first and second-time retreatment pulmonary tubercu- losis(PTB). Methods A prospective multi-center study was performed in the first and second-time retreatment PTB pa- tients. Sputum culture, species identification and drug sensitivity test were performed simultaneously. The differences of drug resistance types and situations were analyzed. Results The total drug resistance rate of the second-time retreatment was significantly higher than that of the first-time retreatment(67.9% vs. 40.5%, P < 0.05). The single resistance rate(25.6%), multi-drug resistance rate(26.9%) and resistance rate to levofloxacin(Lfx)(14.3%)in the second-time retreatment were significantly higher than those of the first-time retreatment(15.1%, 16.6%, 7.1%), P < 0.05. Isoniazid(H) and ri- fampicin(R) resistance rate(46.2%, 39.7%) in the second-time retreatment were significantly higher than those of the first-time retreatment(28.8%, 19.2%), P < 0.05. Conclusion The drug resistance rate is higher in the second-time re- treatment than that of the first time retreatment. The incidence of multi-drug resistance TB and H, R resistant ratio signifi- cantly increase. More attention should be paid for the standard treatment and management on the first-time retreatment pa- tients, in order to reduce the retreatment times, drug resistance test should be made for those patients under more than one time retreatment of PTB.更多还原