武汉市涂阳肺结核患者耐药率及耐药谱分析

Analysis of the drug resistance patterns and resistance rates among smear positive TB patients in Wuhan city

目的分析不同登记分类涂阳肺结核患者的耐药[特别是耐多药结核病(MDR-TB)]特点,了解耐药的危险因素,为制订耐药结核病(特别是MDR-TB)控制策略提供参考。方法对痰涂片阳性的新患者、复治(复发、返回和其他)和治疗失败(初治失败、复治失败和治疗3个月末痰涂片阳性的新患者)3类患者收集2份痰标本进行培养,用比例法进行6种抗结核药物(INH、RFP、EMB、S、Km和Ofx)敏感性试验。2006年12月至2012年3月进行痰培养的涂阳肺结核患者2110例,培养阳性1947例(92.3%);经药物敏感性试验和菌型鉴定,Mtb感染1800例(92.4%)。结果 1800例Mtb感染者中总耐药794例(44.1%,794/1800),其中单耐药结核病(SDR-TB)244例(13.6%,244/1800)、多耐药结核病(PDR-TB)155例(8.6%,155/1800)、MDR-TB 395例(21.9%,395/1800);MDR-TB检出率明显高于SDR-TB和PDR-TB(χ2=43.4,χ2=123.6,P值均<0.01)。新患者、复治及治疗失败3类患者SDR-TB检出率分别为11.9%(57/480)、14.4%(159/1107)及13.1%(28/213),差异无统计学意义(χ2=0.33,P=0.85);3类患者PDR-TB检出率分别为5.4%(26/480)、9.8%(109/1107)及9.4%(20/213),复治与治疗失败PDR-TB检出率差异无统计学意义(χ2=0.04,P=0.84),但高于新患者(χ2=8.53,P=0.01);3类患者MDR-TB检出率分别为14.4%(69/480)、22.5%(249/1107)及36.2%(77/213),经χ2检验,治疗失败患者MDR-TB检出率高于复治和新患者(χ2=17.92,χ2=42.07,P值均<0.01)。结论武汉市涂阳肺结核患者耐药检出率高;耐药成因复杂,耐药谱呈多样性和复杂性,对结核病控制构成威胁。

Objective To analyze the resistance characteristics of different registration classification smear positive TB patients（especially MDR-TB） and to understand the risk factors in order to provide reliable references for development of drug-resistant TB control strategy.Methods Two sputum samples were collected from each smear positive patient in 3 categories-new,re-treatment（relapse,transfer in and others） and treatment failure（failure of new patient,retreatment patient and new patients who remain smear positive after 3 months of treatment） for sputum culture by proportional method,six kinds of anti-TB drugs（INH,RFP,EMB,S,Km,Ofx） were tested for susceptibility.Between December 2006 and March 2012,a total of 2110 cases of smear positive TB patients were sputum cultured,in which 1947 cases（92.3%） were culture positive;through drug susceptibility test（DST） and bacterial typing,1800 cases of Mtb（92.4%） were identified eventually.Results Among the 1800 Mtb cases,a total of 794 cases（44.1%,794/1800） were identified as drug-resistant TB,out of which,244 cases（13.6%,244/1800） were single-drug-resistant（SDR） TB,155 cases（8.6%,155/1800） were poly-drug-resistant（PDR） TB,395 cases（21.9%,395/1800） were MDR-TB,the detection rate of MDR-TB is significantly higher than SDR-TB and PDR-TB（χ2=43.4,χ2=123.6,P0.01）.The detection rate of SDR for new,re-treatment and treatment failure TB patients was 11.9%（57/480）,14.4%（159/1107）and 13.1%（28/213）respectively,the diffe-rence is not statistically significant（χ2=0.33,P=0.85）;the detection rate of PDR for new,re-treatment and treatment failure TB patients was 5.4%（26/480）,9.8%（109/1107） and 9.4%（20/213） respectively,the difference is not statistically significant between retreatment and treatment failure cases（χ2=0.04,P=0.84）.however,they are higher than that of new TB cases（χ2=8.53,P=0.01）;the detection rate of MDR for new,re-treatment and treatment failure TB patients was 14.4%（69/480）,22.5%（249/1107） and 36.2%（77/213）respectively,the detection rate of treatment failure TB patients is higher than that of new and re-treatment TB patients（χ2=17.92,χ2=42.07,P0.01）.Conclusion The detection rate of drug resistant TB is high among smear positive TB patients in Wuhan.The diversity and complexity of drug resistant spectrum poses a threat to TB control in China.