深圳市可疑耐多药病人中的耐药结核病及其耐药谱分布特点

Analysis on situation and pattern of drug resistance tuberculosis in suspected multi-drug resistance patients in Shenzhen

目的研究耐药结核病(DR-TB)在不同类型可疑耐多药结核病人(MDR-TB)中的分布特点及其耐药谱分布情况,为制定MDR-TB控制策略提供科学依据。方法 2006年10月—2009年4月深圳市发现的可疑耐多药结核病人为研究对象,通过痰涂片、培养、菌种鉴定和药物敏感试验诊断MDR-TB,按照可疑MDR-TB患者不同肺结核类型发生耐药和耐多药结核病情况进行统计分析。结果 406例临床分离菌株做药物敏感试验,其中36.2%为MDR-TB,18.9%为其他DR-TB;82例初治可疑MDR-TB患者中,MDR-TB占45.1%;310例复治可疑MDR-TB患者中,MDR-TB占33.2%,以复治失败所占比例最高,为66.7%。147例MDR-TB病例中,初治占28.6%,复治70.1%,新患者1.3%。77例其他DR-TB病例中,初治占22.1%,复治77.9%。初治组2类病例均有较高的MDR-TB和DR-TB发生率;复治组中复治失败病例的MDR-TB发生率最高。MDR-TB中,初治组以耐HRS和HRES为多,复治组以HR和HRES为多;MDR-TB外的其他DR-TB患者中,各耐药谱的耐药频率以单耐药为主,其中耐H或R的频度最高。结论复治组是MDR-TB发生的主要类别,但3个月末涂阳和初治失败患者也存在较高的MDR-TB发生率(实际上此病例已属复治);初、复治组MDR-TB均有较严重的耐药程度,其他DR-TB为发生MDR-TB的高危人群。

Objective To investigate the distribution characteristics and pattern of DR-TB in different types of suspected pulmonary MDR-TB patients and provide scientific evidence for MDR-TB control in Shenzhen. Methods All suspected MDR-TB found during October 2006 to April 2009 were investigated. Sputum smear,culture,bacterial identification and drug susceptibility test were performed for diagnosis of MDR-TB. Statistical analysis was made for the incidence rate of DR-TB and MDR-TB in different types of pulmonary MDR-TB patients. Results 406 isolated strains of Mycobacterium tuberculosis were tested for drug susceptibility,36.2% of them were diagnosed as MDR-TB; MDR-TB accounted for 45.1% and 33.2% respectively in 82 cases of initial and 310 cases of retreatment suspected MDR-TB cases. In the category of retreatment failure,the proportion of MDR-TB is the highest of 66.7%. Among 147 cases of MDR-TB,initial treatment,retreatment and new patients accounted for 28.6%,70.1% and 1.3% respectively. Of the 77 cases of other DR-TB,initial and retreatment PTB accounts for 22.1% and 77.9% respectively. The MDR-TB and DR-TB proportion are both high in two categories under initial treatment group. MDR-TB constituted the highest portion in retreatment failure category under retreatment group. In MDR-TB cases,the highest frequency is resistance to HRS and HRES in initial treatment group and HR and HRES in retreatment group. For other DR-TB patients,the majority is single drug resistance with highest frequency in H and R resistance. Conclusions Retreatment group was the major category for MDR-TB occurrence,however,there are also high MDR-TB incidence in those with smear positive results after 3 months treatment and those with initial treatment failure（in fact,these are already retreatment cases）. Drug resistance is serious in both new and retreatment group. And other DR-TB is high risk population for MDR-TB.