江苏省连云港市肺结核患者耐药状况分析

Analysis of drug susceptibility profiles of Mycobacterium tuberculosis in Lianyungang of Jiangsu province

目的分析江苏省连云港市肺结核患者结核分枝杆菌耐药状况,为今后制定结核病预防控制策略提供依据。方法连续纳入2011年1—9月连云港市各区(县)疾病预防控制中心或结核病定点医院确诊的痰涂片阳性肺结核患者522例,其中初治患者396例,复治患者126例。连云港市第四人民医院实验室采用简单法对所有纳入的522例肺结核患者标本进行结核分枝杆菌固体培养和比例法药物敏感性试验。结果培养阳性的479株结核分枝杆菌中,任意耐药的菌株为151株(31.5%),其中初治患者和复治患者任意耐药率分别为20.9%(76/363)和64.7%(75/116),复治患者任意耐药率显著高于初治患者(χ2=77.84,P<0.001)。此外,初治患者中单耐药率(11.6%,42/363)与复治患者(11.2%,13/116)相近,两者差异无统计学意义(χ2=0.011,P=1.000);而复治患者耐2种药物(18.1%,21/116)、3种药物(17.2%,20/116)及3种药物以上(18.1%,21/116)的率均显著高于初治患者[分别为3.6%(13/363)、1.7%(6/363)、4.1%(15/363)](χ2值分别为28.11、41.61和24.69,P值均小于0.001)。结论江苏省连云港市涂阳肺结核患者耐药疫情比较严重,复治患者为主要耐药人群。

Objective To investigate the prevalence of drug-resistant tuberculosis （TB） in Lianyungang and provide the evidence for strategy development of TB control and prevention. Methods Five hundred and twenty-two smear positive pulmonary TB patients registered from January to September 2011 in the counties were consecutively enrolled, among whom 396 new cases and 126 re-treat cases. Solid culture method was used for sputum culture. The proportion method was used to detect the drug susceptibility of Mycobacterium tuberculosis （M. tuberculosis）. Results Out of 479 isolates in the present study, there were 151 （31.5%） strains resistant to any anti-tuberculous drug. The drug resistant rates to any anti-TB drug among new and re-treated cases were 20.9% （76/363） and 64.7% （75/116）, respectively, and the difference between the two groups was significant （χ2=77.84, P〈0.001）. In addition, the drug resistant rates to single drug were similar among new （11.6%,42/363） and re-treated cases （11.2%,13/116） （χ2=0.011,P=1.000）, while there were more strains resistant to two drugs （18.1%, 21/116）, three drugs（17.2%, 20/116） and more than three drugs（18.1%, 21/116） in the re-treated group than new group （χ2=28.11,41.61,24.69;all P〈0.001）. Conclusion The epidemic situation of smear-positive pulmonary tuberculosis patients with drug resistance is serious, and re-treated patients are the main population with drug resistance.