结核分枝杆菌新疆临床分离株耐药情况调查

Investigation of the drug-resistance of Mycobacterium tuberculosis clinical isolates from Xinjiang

目的分析新疆部分地区结核分枝杆菌(MTB)临床分离株对抗结核药物的耐药情况,探讨本地区耐药结核病的发生率及特点。方法收集2008年11月～2009年10月新疆喀什、和田、皮山等南疆地区确诊的结核病患者痰液标本,进行MTB的分离培养及菌种初步鉴定,并应用比例法对分离菌株进行耐药性检测,与本课题组所做北疆地区耐药情况进行比对。结果共分离到102株分枝杆菌,88株(86.3%)属于结核分枝杆菌复合群,7株(6.9%)属于牛分枝杆菌,7株(6.9%)属于非结核分枝杆菌。88株结核分枝杆菌中对1种以上抗结核药物具有耐药性的有20株,总耐药率为22.7%(20/88),MDR-TB为6.8%(6/88)。新疆南疆地区4种一线抗结药物的耐药率:H15.9%、R8.0%、S12.5%、E3.4%,明显低于新疆北疆地区抗结药物的耐药率:H53.3%、R28.5%、S48.4%、E46.8%。结论新疆南疆地区结核总耐药率有所下降,耐多药率有上升趋势,在结核病防治工作中应给予高度重视;新疆南、北疆地区耐药情况不同,北疆耐药率明显高于南疆地区。

Objective To analyze anti-TB drug resistance in clinical isolates of Mycobacterium tuberculosis（MTB）from several areas of Xinjiang and ascertain the rate of drug resistance and characteristics of MTB in these regions.Methods Sputum samples from patients with TB were collected from Kashi,Hetian,Pishan,and other regions of southern Xinjiang from Nov.2008 to Oct.2009.The separation,culture,and preliminary identification of MTB were done.Anti-tuberculosis drugs were used to detect the drug resistance of MTB via the proportion method,and then the results were compared with those from the northern regions of Xinjiang.Results One hundred and two isolates were obtained：88（86.3%）were members of the MTB complex,7（6.9%）were Mycobacterium bovis,and 7（6.9%）were non-tuberculosis mycobacteria.Among the 88 MTB complex isolates,the general resistance rate to at least one drug was 22.7%;6 isolates（6.8%）were found to be multi-drug-resistant TB（MDR-TB）.In the southern region of Xinjiang,the rate of drug resistance to four kinds of first-line anti-tuberculosis drugs was 15.9% for H,8.0% for R,12.5% for S,and 3.4% for E;these rates were significantly lower than those in the northern region of Xinjiang（53.3% for H,28.5% for R,48.4% for S,and 46.8% for E）.Conclusion The overall rate of resistance has decreased in the southern Xinjiang region,but the rate of MDR-TB has increased,and drug-resistant TB should be give sufficient attention.The southern and northern regions had different levels of drug resistance.The rate of drug resistance in the northern region of Xinjiang was significantly higher than that in the southern region.