结核分支杆菌临床分离株耐药性调查与耐多药结核病流行特点探讨

A survey of the drug resistance in Clinical isolates of Mycobacterium tuberculosis and the epidemic trend of multidrug-resistant tuberculosis

目的调查结核临床分离株的耐药性,探讨多耐药结核病(MDR-TB)流行特点。方法采用匡氏琼脂培养基按比例法测定287株结核菌(56株来自初治病例)对8种抗痨药物的耐药性。结果初治病例菌株和复治病例菌株对异烟肼、利福平、链霉素、吡嗪酰胺高度耐药率分别为1.8%、3.6%、17.9%、0%和74.9%、58.0%、68.4%、32.0%,差异均极显著(P<0.001)。复治病例MDR株占63.2%,广泛耐药(XDR)株占10%,15.8%的MDR株为XDR株;初治病例无XDR株感染,MDR株占1.8%,极显著低于复治病例MDR株比率(P<0.001)。结论住院结核病患者MDR株和XDR株感染率高,且主要由获得性耐药产生。DOTS策略仍是我国耐药结核病防治重点。

Objective To investigate the drug resistance in clinical isolates from the initially treated cases and the relapse cases and to evaluate the prevalent trend in drug-resistant tuberculosis.Methods The susceptibility assays of 8 drugs in 287 clinical isolates of M. tuberculosis （56 strains of those were isolated from initially treated cases ） were performed by pmporation method using Kuangs, agar medium. Results The rate of high resistant strains to isoniazid, rifampin, streptomycin, pyrazinamide were 1.8%, 3.6%, 17.9 %, 0.0%. in initially treated cases and 74.9 %, 58.0%, 68.4%, 32.0%, in relapse cases, respectively, and there were statistic significances between each drug （ P 〈 0.001 ）. The mulfidrug-resistance（MDR） strains in relapse cases occurred in a rate of 63.2% and the extensive drug resistance（XDR） strains in a rate of 10%. 18% of MDR strains was XDR strains.No XDR strain was found in initially treated Cases and the rate of MDR strains was 1.8 %. Conclusion A high rates of hospitaliged patients were infected by MDR and XDR Strains of M. tuberculosis and those MDR bacilli were originated in acquired drug resistance. DOT s Should be still the emphasis of measures in prevention and control of drug-resistant tuberculosis.