首次复治及二次复治菌阳肺结核耐药情况分析

Analysis of Drug Resistances in the First and Second Times Retreatment Pulmonary Tuberculosis with Smear-positive

目的评价首次复治及二次复治菌阳肺结核的耐药情况。方法采用前瞻性多中心研究，对首次及2次复治菌阳肺结核患者行痰罗氏结核分枝杆菌培养、药敏试验，对两组耐药类型、一线及二线抗结核药物耐药情况进行分析。结果二次复治患者抗结核药物总耐药率（67．9％）明显高于首次复治患者（40．5％），差异有统计学意义（P〈0．05）；二次复治患者单耐药率、耐多药率、耐左氧氟沙星（Lfx）率分别为25．6％、26．9％、14．3％，明显高于首次复治患者的耐药率（15．1％、16．6％、7．1％），差异有统计学意义（P均〈0．05）。二次复治患者对异烟肼及利福平的耐药率分别为46．2％、39．7％，均显著高于首次复治病例（28．8％、19．2％），P均〈0．05。结论二次复治肺结核患者耐药率较首次复治病例明显增加，耐多药肺结核发生率及对利福平、异烟肼的耐药率均明显提高，因此应重视首次复冶肺结核患者的规范化治疗，减少复治次数，对复治患者应及时进行药敏试验，以指导临床用药。

Objective To analyze the drug resistance in the first and second-time retreatment pulmonary tuberculosis （PTB）. Methods A prospective multi-center study was performed in the first and second-time retreatment PTB patients. Sputum culture, species identification and drug sensitivity test were performed simultaneously. The differences of drug resistance types and situations were analyzed. Results The total drug resistance rate of the second-time retreatment was significantly higher than that of the first-time retreatment （67.9% vs. 40.5%, P 〈 0.05）. The single resistance rate （25.6%）, multi-drug resistance rate （26.9%） and resistance rate to levofloxacin （Lfx） （14.3%） in the second-time retreatment were significantly higher than those of the first-time retreatment （15.1%, 16.6%, 7.1%）, P 〈 0.05. Isoniazid （H） and rifampicin（R） resistance rate （46.2%, 39.7%） in the second-time retreatment were significantly higher than those of the first-time retreatment （28.8%, 19.2%）, P 〈 0.05. Conclusion The drug resistance rate is higher in the second-time retreatment than that of the first time retreatment. The incidence of multi-drug resistance TB and H, R resistant ratio significantly increase. More attention should be paid for the standard treatment and management on the first-time retreatment patients,in order to reduce the retreatment times, drug resistance test should be made for those patients under more than one time retreatment of PTB.