【摘要】 目的 分析安徽省涂阳肺结核患者的耐药状况和分布情况。方法 采用分层整群抽样方法在安徽省抽取42个调查点,连续纳入2015年9月15日至2016年8月31日3047例涂阳肺结核患者,并进行罗氏固体培养[其中101例痰培养污染(3.31%),275例培养阴性(9.03%),2671例(87.66%)培养阳性]和6种抗结核药物的药物敏感性试验(简称“药敏试验”),包括异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(Sm)、氧氟沙星(Ofx)、卡那霉素(Km),最终有141例鉴定为非结核分枝杆菌(nontuberculosis mycobacteria,NTM),2530例的标本培养成功并获得药敏试验结果。采用SPSS 19.0软件进行统计学分析,计数资料采用χ~2检验,以P<0.05为差异有统计学意义。结果 共获得2530株结核分枝杆菌分离株,对INH、RFP、EMB、Sm、Ofx、Km全部敏感者有1861株(73.56%),对1种或1种以上抗结核药物耐药(以下简称“任一耐药”)者669株(26.44%)。全部(2530株)、初治(84.31%,2133/2530)、复治(15.69%,397/2530)患者的临床分离菌株分别对INH(13.32%,337/2530)、Sm(10.97%,234/2133)、RFP(31.74%,126/397)的耐药率最高。初治患者对INH(10.45%,223/2133)、RFP(7.64%,163/2133)、Sm(10.97%,234/2133)、EMB(1.88%,40/2133)和Ofx(6.52%,139/2133)的耐药率均明显低于复治患者[分别为28.72%(114/397)、31.74%(126/397)、21.91%(87/397)、8.56%(34/397)、21.66%(86/397)](χ~2值分别为96.66、192.07、36.19、52.74、94.76,P值均=0.000)。全部、初治、复治患者耐多药率分别为7.63%(193/2530)、4.97%(106/2133)、21.91%(87/397);多耐药率分别为12.41%(314/2530)、8.95%(191/2133)、30.98%(123/397);广泛耐药率分别为0.91%(23/2530)、0.61%(13/2133)、2.52%(10/397)。结论 安徽省涂阳肺结核患者对“任一耐药”的耐药率较高,对INH的耐药率最高;初治患者对Sm的耐药率最高,复治患者对RFP的耐药率最高。我省耐药结核病疫情不容忽视。更多还原

【Abstract】 Objective To analyze the drug resistance and distribution of smear positive pulmonary tuberculosis patients in Anhui province. Methods Using stratified cluster sampling method, 42 sampling survey points in Anhui province were extracted. A total of 3047 patients with smear-positive pulmonary tuberculosis was collected from September 15, 2015 to August 31, 2016, and were cultured by Roche solid(101 were polluted(3. 31%), 275 were negative(9. 03%), 2671 were positive(87. 66%)) and anti-drug sensitivity test of 6 anti-TB drugs(including isoniazid(INH), rifampin(RFP), ethambutol(EMB), streptomycin(Sm), ofloxacin(Ofx) and kanamycin(Km)) Finally 141 cases were identified as non-tuberculosis mycobacteria(NTM), and results of drug sensitivity test were acquired from 2530 cases. SPSS 19. 0 was used for statistical analysis, and the counting data were analyzed by the χ~2 test. P<0. 05 was considered statistically significant. Results A total of 1861 strains(73. 56%) were all sensitive of INH, RFP, EMB, Sm, Ofx, Km in 2530 strains of Mycobacterium tuberculosis isolates, 669 strains(26. 44%) were resistant to one or more anti-TB drugs. All of them(2530 strains), clinical isolates from initial(84. 31%, 2133/2530) and re-treat patients(15. 69%, 397/2530) had the highest percentages in INH(13. 32%,337/2530), Sm(10.97%, 234/2133), RFP(31.74%, 126/397), respectively. The resistant rates of INH(10.45%, 223/2133), RFP(7. 64%, 163/2133), Sm(10. 97%, 234/2133), EMB(1. 88%, 40/2133) and Ofx(6. 52%, 139/2133) in initial patients were significantly lower than those in re-treat patients(28. 72%(114/397),31.74%(126/397), 21.91%(87/397), 8.56%(34/397) and 21.66%(86/397);χ~2=96.66, 192.07, 36.19,52.74, 94.76, respectively, all P = 0.000). The multidrug resistance rates were 7.63%(193/2530), 1.97%(106/2133) and 21. 91%(87/397) for all, initial and re-treat patients, respectively. The poly-resistance rates were12.41%(314/2530), 8.95%(191/2133) and 30.98%(123/397), respectively. The extensively drug-resistant rates were 0. 91%(23/2530), 0.61%(13/2133) and 2. 52%(10/397), respectively. Conclusion The drug resistance rate of patients with smear positive pulmonary tuberculosis in Anhui province is relatively high for any drug resistance, and the drug resistance rate of INH is the highest. The resistance rate of Sm was the highest in the initial treatment patients, and RFP is the highest in the retreatment patients. The epidemic of drug-resistant tuberculosis in Anhui province cannot be ignored.更多还原