182例肺结核分支杆菌耐药结果的临床分析

Clinical Analysis of Drug Resistance of Pulmonary Mycobacterium Tuberculosis in 182 Cases

了解肺结核患者分支杆菌菌型鉴定结果及初复治耐药现状与临床的关系。方法:对182例分支杆菌培养阳性的肺结核住院病人进行了菌型鉴定和耐药测定,耐药性测定方法和耐药标准按中国防痨协会制定的全国结核病诊断细菌学检验规程进行。结果:菌型鉴定表明182株分支杆菌中人型结核杆菌176株,占96.7％,非典型分支杆菌6株,占3.3％。182株分支杆菌中耐药74株(40.7％),非典型分支杆菌耐药率100％,74株耐药菌对链霉素耐药率最高(60.8％);单一耐药56.8％,耐3种药以上24.3％;初治耐药率28.2％,复治耐药率67.2％,P<0.01;51岁以上老年组耐药率73.2％,明显高于其他年龄组,慢性纤维空洞型肺结核耐药率100％。结论:分支杆菌耐药性与临床肺结核病的类型、病程、年龄均密切相关,分支杆菌的菌型鉴定和耐药性测定对临床诊断与治疗有一定的指导作用。加强对结核分支杆菌耐药的监测,化疗的管理,实行科学的临床用药,是降低结核病耐药率最有效的措施。

To investigate the classification of the raycobacterium in pulmonary tuberculosis patients and the relationship between drug - resistance status and their clinical features. Methods:Type classification and drug resistance evaluation were carried out in 182 cases,according to the standard technique established by The Chinese Association of Tuberculosis Prevention. Results: Type classification indicated that among 182 strains, 176 strains (96.7%) belonged to the human type,6 of them(3.3% )were non - typical. 74 in all the strains were drug - resistant, and non - typical mycobacteria were 100% drug - resistant. Most strains were SM(60.8%) resistant,56.8% of total were resistant to one drug,24.3% were multidrug(more than three)resistant.28.2% drug resistant cases were found during their first treatment, others had experienced more than one period of medication.73.2% cases whose age was above 51 were drug resistant, which ratio was significantly higher than other groups. A 100% resistant ratio was observed in stage IV tuberculosis. Conclusion: The drug resistant status of tubercle bacillus is strongly correlated with type, course of diseases and age. Type verification and drug sensitivity tests are instructional in treatments which could lead to reasonable medication and final control of drug- resistant pulmonary tuberculosis.