202例肺结核患者痰培养阳性菌株耐药性分析

Analysis of drug resistance of Mycobacterium tuberculosis isolated from sputum of 202 patients with pulmonary tuberculosis

目的了解某市胸科医院住院患者痰标本分离结核分枝杆菌的耐药情况。方法回顾性调查该院2003年1月1日2006年12月31日所有新发和复治的肺结核病患者痰标本分离结核分枝杆菌对异烟肼、链霉素、乙胺丁醇和利福平的敏感性。结果4年间202例住院肺结核患者痰标本分离的结核分枝杆菌总耐药率为39．11％（79／202），总耐多药率为10．89％（22／202）。初始耐药率为35．11％，获得性耐药率为46．48％。获得性耐多药率16．90％，明显高于初始耐多药率7．63％（x^2=4．08，P=0．049）。2004年度获得性耐多药率36．36％，明显高于初始耐多药率5．66％（x^2=5．95，P=0．02）；2006年获得性耐多药率与初始耐多药率相同，均为13．51％。复治患者对异烟肼、链霉素、利福平均显示较高的耐药性，耐药率分别为47．89％、46．48％、36．62％，复治患者耐多药率为35．21％；初治患者单耐药率和多耐药率均为16．03％。结论耐药和耐多药肺结核病疫情严重，特别是初始耐药和耐多药结核病，故有效控制耐药结核病是我们当前所面临的紧迫任务。

Objective To investigate drug resistance of Mycobacteriurn tuberculosis （M. tuberculosis） isolated from inpatients with pulmonary tuberculosis in Shenyang Chest Hospital in recent 4 years. Methods Retrospective analysis of drug susceptibility test of M. tuberculosis to isoniazid（INH）, streptomycin（SM）, ethambutol （EB） and rifampicin （RFP） was conducted, M. tuberculosis were isolated from new cases and retreated pulmonary tuberculosis patients with positive sputum culture in Shenyang Chest Hospital from January 1, 2003 to December 31, 2006. Results The total drug-resistant rate of M. tuberculosis was 39. 11% （79/202）, multidrug-resistant rate was 10. 89% （22/202）. The initial drug-resistant rate and acquired drug-resistant rate was 35. 11 % and 46.48 % respectively. The acquired multidrug-resistant rate was 16. 90% ,which was obviously higher than that of initial multidrug resistant rate of 7. 63%（x^2 = 4. 08,P = 0. 049）. In 2004, the acquired multidrug-resistant rate （36. 36%） was obvi ously higher than that of initial multidrug-resistant rate （5.66%） （x^ = 5.95,P = 0. 02）. However in 2006, the two rates were the same（13.51 %）. The retreated patients showed a higher drug resistance to INH （47. 89%）, SM （46. 48%） and RFP （36.62%）. Multidrug-resistant rate of retreated patients was 35.21%, single drug-resistant rate and multidrug-resistant rate of initial patients were both 16. 03%. Conclusion The results showed that the drug resistance and multidrug resistance of puhnonary tuberculosis are still serious, especially the initial drug resistance and multidrug resistance. So effective control of drug resistant tuberculosis is critical task currently.