浙江省耐多药结核病例中二线耐药状况分析

Analysis on second-line drug resistance situation of multiple drug resistant tuberculosis in Zhejiang,China

目的通过对肺结核病耐药状况和耐药趋势的调查研究,掌握浙江省目前主要二线抗结核药的耐药状况,为耐药结核病疫情控制提供科学依据。方法在全省随机抽取30个县区作为样本县,将选例期间发现的1 077例涂阳病例纳入耐药监测;按《结核病诊断细菌学检验规程》规定要求进行分离培养、分枝杆菌菌种初步鉴定,用H37RV标准菌株常规质控监测,先使用比例法筛选耐药病例,对入组二线抗结核药耐药监测病例的菌株再使用绝对浓度法检测。结果在耐多药(MDR)病例中各种二线抗结核药物的耐药率卡那霉素(K)9.62%,卷曲霉素(CPM)11.54%,丁胺卡那霉素(AK)7.69%,环丝氨酸(CS)5.77%,氧氟沙星(OFLX)28.85%,对氨基水杨酸(PAS)32.69%。MDR病例中广泛耐药结核病(XDR)耐药率3.85%。结论调查结果显示浙江省的二线抗结核药物耐药状况比较严重,耐药结核病的控制面临挑战,有必要在今后的工作中进一步提高现代结核病控制策略(DOTS)执行质量,加强实验室对MDR、XDR的检测能力,完善耐药结核病诊疗管理综合体系建设。

Objective To investigate mycobacterium tuberculosis drug resistance to second-line drugs in Zhejiang and provide a scientific basis for the prevention and control of drug-resistant TB epidemic.Methods We randomly selected 30 counties for the study.Samples from the selected counties were entered into the group of surveillance if the specimens were smear-positive.The procedures of mycobacterium isolation,culture and primary species identification were performed under the guidelines of the Laboratory Procedure of Diagnostic Bacteriology in Tuberculosis.Results The surveillance group had 1 077 smear-positive tuberculosis specimens.Among multiple drug resistant（MDR） cases,the rates of anti-tuberculosis drug resistance to second-line drugs were 9.62%,11.54%,7.69%,5.77%,28.85% and 32.69% respectively for kanamycin（K）,capreomycin（CPM）,amikacin（AK）,cycloserine（CS）,ofloxacin（OFLX） and para-Aminosalicylate（PAS）.The extensive drug resistance（XDR） rate of MDR cases was 3.85%.Conclusion Tuberculosis drug resistance to second-line drugs was in a serious situation in Zhejiang.We should enhance the implementation quality of Directly Observed Treatment Short-course（DOTS）,strengthen the detection capability of MDR and XDR,as well as improve the medical treatment comprehensive system for drug resistance TB.