656株结核分支杆菌耐药状况分析

Investigation of Drug Resistance Status of 656 Strains of Mycobacterium Tuberculosis

目的了解天津市结核病患者的耐药状况,为耐药结核病防治提供参考依据。方法选用2008年1月至2009年6月在天津市结防机构就诊的结核分枝杆菌分离培养阳性肺结核患者。采用"世界卫生组织国际防痨与肺部疾病联合会"推荐的比例法,对研究对象初次分离培养获得的菌株进行利福平(rifampicin,RFP)、异烟肼(isoniazid,INH)、链霉素(streptomycin,SM)和乙胺丁醇(ethambuol,EMB)的药物敏感实验。运用横断面调查的方法描述耐药结核病的流行情况。结果共纳入肺结核患者656例,总耐药率为26.98%,复治患者耐药率明显高于初治患者耐药率(χ2=13.54,P=0.000);耐药顺位为链霉素>异烟肼>利福平>乙胺丁醇;初、复治患者均以单耐药为主;总耐多药率为6.25%,复治患者耐多药率明显高于初治患者(χ2=47.09,P=0.000)。结论天津市结核病患者耐药流行情况尚不严重,以单耐药为主要耐药形式,复治患者为主要耐药人群。今后应特别加强对初治病人的治疗管理,严格执行结核病控制策略,减少复治病例,加强耐药结核病监测,有效预防和控制耐药结核病的产生和蔓延。

Objective To investigate the prevalence of the drug-resistant tuberculosis of this area and provide the evidence for the control and prevention. Methods A cross-sectional study was conducted to describe the drug-resistant tuberculosis prevalence in Tianjin： The subjects were all culture-positive pulmonary tuberculosis patients newly diagnosed or retreated in Tianjin tuberculosis control institutions from January 2008 to June 2009. The proportion method recommended by WHO/IUATLD was used for testing the strains＇ susceptibility to rifampicin, isoniazid, streptomicin and ethambutol. Results 656 subjects were included, the prevalence of overall resistance among all cases was 26.98%, the drug-resistance rate of the re-treatment cases was higher than that of new cases （X2=13.54, P=0.000）; SM〉INH〉RFP〉EMB; Single drug resistant was the mainly pattern of the area, the prevalence of MDR-TB among all cases was 6.25%, and the rate of re-treated cases was much higher than that of new cases （x2=47.09,P=0.000）. Conclusion The status of drug resistance tuberculosis in this area is not so serious, single drug resistant is the main pattern, and the re-treated cases are the main prevalence people of drug-resistant. We must strengthen the treatment and management of the new cases, reduce the number of re-treated cases, and implement the strategies and the surveillance seriously to prevent against drug-resistance tuberculosis.