结核分枝杆菌对氧氟沙星、左氧氟沙星耐药性动态研究

Dynamic Monitoring of Resistance of Mycobacterium tuberculosis to Ofloxacin and Levofloxacin

目的了解菌阳肺结核患者对氟喹诺酮类药物的耐药动态演变,为制定临床标准化治疗方案提供参考依据。方法选取天津市海河医院门诊及住院菌阳肺结核患者,对其结核分枝杆菌(MTB)临床分离株,做氧氟沙星(OFLX)、左氧氟沙星(LVFX)药敏试验。试验分别于2000年、2005年和2009年进行三次。结果初治敏感菌株中30%～60%有氟喹诺酮类药物使用史,OFLX和LVFX耐药率呈现上升趋势。复治耐药患者曾采用过2～12个月不等的含氟喹诺酮类药物化疗方案治疗,至2009年OFLX耐药率59.6%,LVFX耐药率44.2%。氟喹诺酮药物间存在交叉耐药。结论 OFLX、LVFX两药用于复治耐药结核分枝杆菌患者,其耐药率正在迅速上升。这种变化与氟喹诺酮类药物在临床广泛应用及不恰当应用有关。试管内耐药浓度与耐药率呈负相关。制定标准方案时LVFX优于OFLX,但其具体疗效有待于进一步观察。

Objective To observe the ofloxacin and levofloxacin drug resistance evolution of Mycobacterium tuberculosis, which will provide a reference standard for the development of clinical treatment programs. Method the patients with sputum positive came from Tianjin Haihe hospital out-patient and in-patient treatment in 2000, 2005, 2009. Through drug sensitivity test we got the ofloxacin and levofloxacin drug resistance about Mycobacterium tuberculosis. Results The history of using quinolone has 30%-60% in sensitive strains of untreated patients, the ofloxacin and levofloxacin drug resistance take on escalating trend. Re-treated patients are all using different quinolone drug for therapy about 2-12 months, The resistance rate of OFLX is 59.6% and LVFX is 44.2% in 2009. Conclusions The OFLX and LVFX resistance rate of Mycobacterium tuberculosis is quickly going up when they are used for retreat tuberculosis patients, which is related to clinical extensive and appropriate application of quinolones. Vitro drug concentration was negatively correlated with drug resistance. LVFX is better than OFLX in chemotherapy, but the effect remains to be observed.