321例耐多药结核病耐药情况分析

An analysis of 321 cases of multidrug-resistance tuberculosis patients

目的了解原发性与获得性MDR-TB患者年龄分布特征及临床耐药情况,为MDR-TB的防治提供科学依据。方法收集广州市胸科医院2005年1月至2010年12月期间收治的321例MDR-TB患者(原发性耐多药47例、获得性耐多药274例)耐药情况等资料,将患者年龄分为4组,其中<20岁组5例,20～岁组183例,40～岁组105例,60～岁组28例,分别分析其耐药情况。结果原发性耐多药和获得性耐多药患者中,均以20～岁组的比例最高,分别有30例(63.8%,30/47)和153例(55.8%,153/274),但两者与不同年龄组患者[原发性耐多药<20岁组1例(2.1%),40～岁组14例(29.8%),60～岁组2例(4.3%);获得性耐多药<20岁组4例(1.5%),40～岁组91例(33.2%),60～岁组26例(9.5%)]的比较,差异无统计学意义(Fisher确切概率法,P=0.515)。不同年龄组耐一线药分布(分别耐HR、HRE、HRS、HRSE),在原发性耐多药患者中,<20岁组1例(耐HRS 1例,其余0例);20～岁组30例(耐HR 10例,耐HRE 13例,耐HRS 5例,耐HRSE 2例);40～岁组14例(耐HR 4例,耐HRE 7例,耐HRS 3例,耐HRSE 0例);60～岁组2例(耐HRE和HRS各1例,耐HR和HRSE均0例)]。而获得性耐多药中,<20岁组4例(耐HR、HRE、HRS、HRSE各1例,均占25.0%);20～岁组153例(耐HR 56例,占36.6%;耐HRE 26例,占17.0%;耐HRS 46例,占30.1%;耐HRSE 25例,占16.3%);40～岁组91例(耐HR34例,占37.4%;耐HRE 26例,占28.6%;耐HRS 17例,占18.7%;耐HRSE 14例,占15.4%);60～岁组26例(耐HR和HRS各5例,均占19.2%;耐HRE 13例,占50.0%;耐HRSE 3例,占11.5%),差异有统计学意义(Fisher确切概率法,P=0.030);进一步两两比较,20～岁组和60～岁组间的分布差异有统计学意义(χ2=14.32,P=0.002)。原发和获得性耐多药患者耐二线药物[阿米卡星(Am)、克拉霉素(Clr)、左氧氟沙星(Lfx)、莫西沙星(Mfx)、对氨基水杨酸钠(PAS)、利福布丁(Rfb)、丙硫异烟胺(Pto)共7种]都以耐1～2种为最多,分别为25例(53.2%)、115例(42.0%),但两组分布差异无统计学意义(χ2=3.123,P=0.210)。结论原发性和获得性MDR-TB以年轻患者为主,耐多药情况较为严重,应加强结核病患者的诊治,减少耐多药现象。

Objective To understand the age distribution of primary and acquired MDR-TB patients and the status of their drug resistance, and provide a scientific basis for prevention and treatment of MDR-TB. Methods We made a retrospective analysis of MDR-TB cases admitted in our hospital between January 2005 and December 2010 （47 cases of primary and 274 cases of acquired multidrug-resistant cases respectively）. Patients were divided into 4 groups by age, 5 cases in ~20 age group, 183 cases in 20-- age group, 105 cases of 40-- age group, and 28 cases of 60- age group, respectively, to analyze the status of TB drug resistance. Results In 47 primary and 274 acquired MDR cases, age between 20 to 30 had the highest number of cases, which were 30 （63.8%）and 153 （55.8%） respectively. However the difference of primary and acquire MDR-TB distribution in different age group is not statistically significant（primary MDR-TB： 1 case of 〈20 age group （2.1%）, 14 cases of age over 40 （29.8%）, 2 cases of age over 60（4. 3%）, acquired MDR-TB： 4 cases of 〈20 age group（1.5G）, 91 cases of age over 40 （33.2%）, 26 cases of age over 60 （9.5%）. （Fisher＇s exact test, P=0. 515）. As for the distribution of the firstline drug resistance （respectively, resistance to the HR, HRE, HRS and HRSE）, in primary MDR cases, 1 cases in 〈20 age group （resistant to HRS）, 30 cases of age over 20 （10 resistant to HR, 13 to HRE,5 to HRS, and 2 to HRSE）, 14 cases of age over 40 （4 resistant to HR, 7 to HRE, 3 to HRS）, 2 cases of age over 60 （1 resistant to HRE and 1 to HRS）. In acquired MDR-TB cases, 4 cases in 〈20 age group （resistant to HR, HRE, HRS and HRSE respectively）, 153 cases of age over 20 （56 （36.6%） resistant to HR, 26（17.0%） to HRE,46（30.1G） to HRS, and 25（16.3G） to HRSE）, 91 cases of age over 40 （34（87.4%） resistant to HR, 26（28.6%） to HRE, 17 （18.7%） to HRS, 14（15.4%）to HRSE）, 26 cases of age over 60 （5（19.2%） resistant to HR and 5（19.2% to HRS, 13（50. 0%）to HRE, 3（11.5%） to HRSE）. The distribution is statistically significant different between different age group （Fisher＇s exact test, P=0. 030）. Further multiple comparison found that the difference is statistically significant between 20-- age group and 60-- age group. In primary MDR and acquired MDR cases, they were mainly resisted to one or two second-line drugs（seven drugs in total amikacin （Am）, clarithromycin （Clr）, levo- floxacin （Lfx）, moxifloxacin （Mfx）, sodium aminosalicylate （PAS）, rifabutin （Rfb）, propylthiouracil isonicotinoyl amine （Pto）], the resistant rate were 25（53.2%） and 115（42.0~/00） respectively, however the difference is not statistically significant （252 =3. 123,P=0. 211）. Conclusion The primary and acquired MDR-TB predominantly affects young people, and the situation of MDR-TB is serious. We should strengthen the diagnosis and treatment of TB patients, and reduce the incidence of multi-drug-resistant.