223例住院煤工尘肺肺结核患者耐药情况分析

An analysis of the drug resistance situation of 223 inpatient coal workers of pneumoconiosis-tuberculosis

目的了解煤工尘肺肺结核患者耐抗结核药物情况,探寻其防治策略。方法收集2009年1月至2012年12月北京京煤集团总医院尘肺肺结核科住院并确诊的223例煤工尘肺肺结核患者临床资料,分析其耐药情况,采用描述性统计的方法,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果223例患者抗结核药物总耐药率为42.60%(95/223),耐药患者中初治占26.32%(25/95)、复治占73.68%(70/95),二者比较差异有统计学意义(χ2=58.436,P<0.01);多耐药率为50.53%(48/95)、耐多药率为34.74%(33/95)、广泛耐药率为7.37%(7/95);在检测的抗结核药物中,耐一线抗结核药物依次为H 73.68%(70/95)、S 70.53%(67/95)、R 64.21%(61/95)、E 50.53%(48/95),耐二线抗结核药物前4位依次是Km 44.21%(42/95)、PAS 36.84%(35/95)、Ofx 35.79%(34/95)、Pto 24.21%(23/95);初治患者对一线抗结核药物耐药顺位是S>H>R>E[耐药率分别为76.00%(19/25)、56.00%(14/25)、52.00%(13/25)、44.00%(11/25)],对二线抗结核药物耐药主要是Km(48.00%,12/25)、Ofx(44.00%,11/25);复治患者对一线抗结核药物耐药顺位是H>S>R>E>Z[耐药率分别为80.00%(56/70)、68.57%(48/70)、67.14%(47/70)、52.86%(37/70)、7.14%(5/70)],对二线抗结核药物耐药前5位是Km>PAS>Ofx>Pto>Lfx[耐药率分别为42.86%(30/70)、40.00%(28/70)、32.86%(23/70)、25.71%(18/70)、15.71%(11/70)],且耐药品种较初治患者明显增多。结论煤工尘肺肺结核住院患者耐药状况较严重,应加强其卫生管理、治疗方法的研究。

Objective To understand the drug resistance situation of coal workers of pneumoconiosis-tuber- eulosis, and to explore the control strategy. Methods The clinical data of 223 coal workers lived in the General Hospital of Beijing Jingmei Group and diagnosed with pneumoconiosis-tuberculosis from January 2009 to December 2012 were collected and the drug resistance situation was analyzed. Descriptive statistics was employed and ;χ2 test was applied to categorical data. P〈0.05 was set to be the criteria of statistical significance. Results The overall drug resistance rate was 42.60% （95/223）, among whom 26.32% （25/95） were new cases and 73.68% （70/95） were retreatment cases, and the difference was significant between the two types （χ2 = 58. 436, P〈0.01）. The poly-resistance rate was 50.53% （48/95）, the muhidrug-resistance rate was 34.74% （33/95） and the extremely drug resistance rate was 7. 37% （7/95）. The mono-resistance rates of first-line drugs were 73. 68%（70/95） for H, 70. 53% （67/95） for S, 64.21% （61/95） for R, 50.53）% （48/95） for E, and those of second-line drugs were 44.21% （42/95） for Kin, 36.84% （35/95） for PAS, 35.79% （34/95） for Ofx and 24.21% （23/95） for Pto. The order of drug resistance rate of new cases to first-line drugs in descending order was S〉H〉R〉E, and the drug re- sistance rates were 76.00% （19/25）, 56.00% （14/25）, 52.00% （13/25） and 44. 00% （11/25） respectively. Km （48.00%, 12/25） and Ofx （44.00%, 11/25） were the main second-line drugs to which that new cases were resist- ant. The order of drug resistance rate of retreatment cases to first-line drugs in descending order was H〉S〉R〉 E〉Z, and the drug resistance rates were 80.00%/＇0 （56/70）, 68. 570//00 （48/70）, 67.14%/00 （47/70）, 52.86% （37/70） and 7. 14%（5/70） respectively. The order to second-line drugs were Km〉PAS〉Ofx〉Pto〉Lfx, and the rates were42.86% （30/70）, 40.00% （28/70）, 32.86% （23/70）, 25.71%0 （18/70） and 15.71% （11/70）, and the number of resistant drugs was significantly higher than new cases. Conclusion The drug resistance of inpatient coal workers of pneumoconiosis-tuberculosis is serious. The study on management and treatment methods should be strengthened to improve the situation.