论临床结核病耐药性变化趋势的动态监测分析与研究

Research and analysis on the monitoring of clinical TB resistance

目的对临床结核病耐药性的变化趋势的动态监测的方法进行探讨。方法选择2008年至2011年经确诊的2000例肺结核患者作为研究对象,对其耐药菌株进行治疗前与治疗后的动态监测,并对药敏结果进行统计与分析,最终确定治疗前后耐药菌谱的变化情况。结果本组2000例肺结核患者的耐药均值在治疗前与治疗后对抗结核药物的耐单药例数是有一定差异的,以乙胺丁醇(Ethambutol,EMB)药物的耐药例数发生了较为明显的变化,耐药性显著增加,前后对比呈显著的统计学差异(P<0.01);对丁胺卡那霉素(Amikacin,AMK)、卷曲霉素(Capreomycin,CPM)以及对氨基水杨酸(Sodium Aminosalicylate,PAS)三种药物的初始耐药率及复敏率较高。结论对耐多药肺结核患者的耐药菌株进行动态监测,可以准确获取耐药菌株耐药性信息,具有重要的临床意义与价值;同时对目前使用EMB等药物治疗的方案提出警示与质疑,尽快地开发新一代的毒性低、效率高的抗结核药物是目前解决抗结核治疗困境的一个当务之急。

Objective To investigate the dynamic monitoring of clinical TB resistance trends. Methods Chose 2000 cases of tuberculosis patients as the object of study during 2008 - 2011. And monitor the drug - resistant strains before and after treatment, then gave drug susceptibility results of statistics and analysis. Finally determined before and after treatment - resistant changes in drug bacterial spectrum. Results The mean of this group of 2000 patients with pulmonary tuberculosis resistant before and after treatment, the number of resistance to single agent anti - TB drugs was certain difference to the number of drug - resistant cases of Ethambutol （ Ethambutol, EMB） drugs the more obvious changes in resistance were significantly increased, before and after comparison showed a statistically significant difference （ P 〈 0. 01 ） ; Amikacin （AMK）, capreomycin （CPM） and amino salicylic acid （Sodium Aminosalicylate, PAS） three initial drug resistance rate and higher rate of resensitization. Conclusions The dynamic monitoring of multi - drug resistant tuberculosis in patients with drug - resistant strains, can accurately obtain the drug - resistant strains of resistance, have important clinical significance and value; Warning EMB and other drug treatment programs and queries, as soon as possible to develop a new generation of low toxicity, high efficiency anti - TB drugs is an urgent task to solve the predicament of anti -TB treatment at present.