广东省佛山市肺结核患者耐药情况分析

Study on the status of drug-resistant tuberculosis in Foshan, Guangdong Province

对佛山市2011年1月至2014年12月确诊登记的1546例痰涂片阳性肺结核患者的痰标本进行培养，对分离得到的分枝杆菌菌株1546株进行菌种鉴定和药物敏感性试验，非结核分枝菌感染的患者57例，因菌株污染等无法进行耐药分析者423例，最终纳入耐药分析的患者1066例，得到总耐药率、耐多药率分别为21．76％（232／1066）、5．53％（57／1066），初治、复治患者耐多药率分别为2．50％（22／880）、18．82％（35／186）；四种一线抗结核药物的耐药率顺位依次是：S（15．38％，164／1066）、H（11．44％，122／1066）、R（8．07％，86／1066）、E（3．38％，36／1066）。2011-2014年每年的总耐药率分别为22．06％（105／476），23．50％（55／234），22．64％（36／159），18．27％（36／197），耐多药率分别为3．15％（15／476），7．26％（17／234），8．18％（13／159），6．09％（12／197），均呈现先上升后下降的趋势（χ2=11．527，P=0．009；χ2=8．965，P=0．03）。佛山市肺结核总体耐药率和耐多药率相对较低，但总体疫情仍不可忽视，应加强对结核病患者的健康教育工作。

A total of 1546 sputum smear-positive pulmonary tuberculosis （TB） patients, who were registered from January 2011 to December 2014 in Fuzhou City, were enrolled in this study and the sputum culture was performed on them. Subsequently, the strain identification and drug susceptibility test （DST） were performed on the culture-positive patiems. It is found that 57 cases were non tuberculous mycohacterium （NTM） infections and 423 cases did not have DST results due to culture-negative, contamination and so on. Those patients were not included in the drug-resistance analysis while 1066 patients were finally analyzed on the status of drug resistance. The overall drug resistance rate and the multi drug resistance （MDR） rate were 21.76% （232/1066） and 5.53% （57/1066） re- spectively; the MDR rate in the initial treatment TB patients and retreatment TB patients was 2.50% （22/880） and 18. 82% （35/186） respectively. The mono-resistance rate to four first-line anti-TB drugs, from high to low, was 15.38% （S）, 11.44% （H）, 8.07% （R） and 3.38% （E） respectively. From 2011 to 2014, the yearly overall drug resistance rate was 22.06% （105/476）, 23.50%% （55/234）, 22.64G （36/159） and 18.27G （36/197） respectively, the yearly MDR rate was 3.15% （15/476）, 7.26% （17/234）, 8.18% （13/159） and 6.09G% （12/197） respectively, the tread of both rates increased at first and then decreased （χ2 = 11. 527, P=0. 009;χ2=8. 965, P=0.03）. This study implies that the overall drug resistance rate and the MDR rate in pulmonary TB patients in Foshan City were relatively low, but the current situation should not to be ignored. The health education to TB patients should be strengthened.