165例耐多药肺结核病人治疗前后耐药谱的变化分析

Analysis of drug resistance in 165 multidrug-resistance pulmonary tuberculosis patients before and during the treatment

目的了解耐多药肺结核病人在抗结核治疗过程中的耐药状况及其变化趋势。方法对确诊的165例耐多药肺结核病人的耐药菌株,进行治疗前、后药敏结果的比较和分析,并统计治疗前后耐药菌谱变化情况。结果165例耐多药肺结核病人的耐药菌株在治疗前、后对抗结核药物的耐单药例数是有变化的,以乙胺丁醇(ethambutol,EMB)、力克肺疾(pasin iazid,PSNZ)、左氧氟沙星(levofloxacin,LVFX)三种药物的耐药例数改变明显,获得耐药性增加;对丁胺卡那霉素(am ikacin,AMK)、卷曲霉素(capreomycin,CPM)、对氨基水杨酸(sod ium am inosalicylate,PAS)三种药物的初始耐药率和获得耐药率较低、复敏率较高。结论对耐多药肺结核病人的耐药菌株,适时监测其耐药谱,获取更新更全面的药敏资料,是有较大意义的;建议治疗耐多药方案中可推广使用AMK、CPM、PAS;同时对目前以LVFX、EMB、PSNZ为主要组成的耐多药方案提出了警示和挑战,尽快开发新一代的低毒高效的抗结核药物是解决目前抗结核治疗困境的当务之急。

Objective To understand the status and trend of drug resistance of muhidrug-resistanee pulmonary tuberculosis during treatment. Methods The drug resistance between the first and last drug sensitivity test was compared in 165 multidrug-rcsistance pulmonary tuberculosis patients before and after treatment. Results The drug resistance to anti-tuberculosis drugs was different after treatment, which was significant of ethambutol, pasiniazid, levofloxacin, and drug therapy may increase their resistance. For amikacin, capreomycin and sodium aminosalicylate, the initial drug-resistance rate was lower, the acquired drugresistance rate was lower, and the drug re-suscepti- bility rate was higher. Conclusion For the multidrug-resistance pulmonary tuberculosis patients, the supervision of drug resistance can play practical significance in anti-tuberculosis treatment before and during the treatment. We propose that the treatment of these cases should use amikacin, capreomyein and sodium aminosalicylate. The clinical chemotherapy regimens of multidrug-resistance containing ethambutol, pasiniazid ,levofloxacin will be doubted and challenged. It is the top priority to further develop the effective and low-toxicity drugs.