上海地区结核分枝杆菌分离株对一线和二线抗结核药物的耐药性分析

Analysis on first- and second-line drug resistant patterns in 518 Mycobarterium tuberculosis strains in Shanghai

目的了解结核分枝杆菌分离株对一线和二线抗结核药物的耐药性。方法收集2008年1月至2009年3月采用Bactec—MGIT960检测的518株结核分枝杆菌，分析药物敏感试验结果。数据行X^2检验。结果518株结核分枝杆菌菌株对一线和二线抗结核药物全敏感168株，占32．44％；耐药350株，占67．56％；单耐药72株，占13．90％；耐两种药24株，占4．63％；耐三种及以上药254株，占49．03％。217株为耐多药菌株，占所有病例的41．89％。65株为广泛耐药菌株，占所有病例的12．55％，占耐多药菌的29．95％。在一线药物中，耐异烟肼有278株，耐药率达53．67％；二线药物中，耐氧氟沙星有206株，耐药率达39．77％。433例复治患者任一药物耐药率、耐多药率和广泛耐药率分别为72．05％、46．42％和13．86％，均高于初治患者的44．70％、18．82％和5．88％（X^2=24．253，X^2=22．229，X^2=4．117，均P〈0．01）。结论上海地区结核病专科医院结核分枝杆菌分离株的耐药率高，且耐多药与广泛耐药率也较高，在复治患者中耐药情况更严重。

Objective To investigate the resistant patterns of Mycobacterium tuberculosis （MTB） strains against first- and second-line anti-tuberculosis drugs. Methods Drug susceptibility tests of 518 MTB strains collected from January 2008 to March 2009 were performed using Bactec- MGIT 960. The data were analyzed by chi square test. Results In 518 strains, 168 （32.44%） were all sensitive to all seven drugs, 350 （67.56%） were resistant to at least one drug. Among all strains, 72 （13.9%） were resistant to one drug, 24 （4. 63%） were resistant to two drugs, 254 （49.03%） were resistant to three or more drugs. A total of 217 strains （41.89 %） were classified as multi drug resistant tuberculosis （MDR-TB） strains and 65 （12.55%） were extensively drug resistant tuberculosis （XDR-TB） strains which accounted for 29.95% of MDR-TB strains. The drug resistant rate of isoniazid which belonged to first-line drugs was 53.67% （278 strains） and that of ofloxaein which belonged to second-line drugs was 39.77% （206 strains）. In 433 retreated patients, the drug resistant rate against any drugs, MDR rate and XDR rate were 72.05%, 46.42% and 13.86%, respectively, which were all higher than those in treatment naive patients （44.70%, 18.82% and 5.88%, respectively; X^2 = 24. 253, X^2 = 22. 229 and X^2 = 4. 117, respectively; all P 〈 0.01）.Conclusions The resistant rate of MTB is high in a tuberculosis specialized hospital in Shanghai, and MDR TB also shares a high resistant rate as well as XDR-TB. Furthermore, drug resistance is more common in retreated patients.