440例耐多药肺结核病人的结核分枝杆菌药物敏感性试验结果

Drug sensitivity test results of Mycobacterium tuberculosis in 440 patients with multidrug-resistant pulmonary tuberculosis

目的研究连续5年同期内耐多药肺结核病人的结核分枝杆菌耐药情况,探讨其在耐多药肺结核诊治中的价值。方法应用MGIT960液体快速培养及绝对浓度法,测定耐多药肺结核病人结核分枝杆菌的药物敏感性。结果通过回顾性分析2013年1月~2017年6月同期440例耐多药肺结核病人的结核分枝杆菌药物敏感性试验结果,发现耐多药肺结核病人趋于年轻化;临床常规用药均以低浓度耐药为主,其中利福平(RFP)、异烟肼(INH)、链霉素(SM)和利福布汀(RFB)高浓度耐药比例均超过50%;交叉耐药显示,同时对RFP+INH+SM耐药的比例最高,耐药率为26. 36%(116/440),而RFP+INH+SM+左氧氟沙星(LVF)、RFP+INH+SM+乙胺丁醇(EMB)、RFP+INH+SM+EMB+LVF同时耐药比例均超过10%。结论分析发现,很大比例耐多药肺结核病人的结核分枝杆菌对于临床常规用药已经产生了抗性,提示临床医生需制定合理的化疗方案和指导临床耐多药病人合理用药,以便控制难治性结核病大范围的蔓延。

Objective To study the drug resistance of Mycobacterium tuberculosis in patients with multidrug-resistant pulmonary tuberculosis for 5 consecutive years,and to explore its value in the diagnosis and treatment of multidrug-resistant tuberculosis( MDR-TB). Methods The drug sensitivity of Mycobacterium tuberculosis in multidrug-resistant tuberculosis patients was determined by MGIT960 liquid rapid culture and absolute concentration method. Results By retrospectively analyzing the results of drug sensitivity test of Mycobacterium tuberculosis in 440 patients with multidrug-resistant pulmonary tuberculosis from January2013 to June 2017,it was found that patients with multi-drug resistant tuberculosis tend to be younger. Low concentration drug resistance was the main clinical routine drug. The high-dose resistance ratio of rifampicin( RFP),isoniazid( INH),streptomycin( SM) and rifabutin( RFB) exceeded 50%. Cross-drug resistance showed that the proportion of resistance to RFP + INH + SM was the highest,with the resistance rate of 26. 36%( 116/440),while the proportions of resistance to RFP + INH + SM + levofloxacin( LVF),RFP + INH + SM + ethylamine butanol( EMB) and RFP + INH + SM + EMB + LVF were over 10%. Conclusion The drug sensitivity test of Mycobacterium tuberculosis has found that a large proportion of MDR-TB patients have developed resistance to clinical routine medication use,suggesting that clinicians need to develop reasonable chemotherapy regimens and guide the rational use of drugs in clinical multidrug-resistant patients in order to control the widespread of tuberculosis.