黄山市结核病耐药性基线调查结果分析

Baseline survey of tuberculosis resistance in Huangshan

目的了解黄山市耐药结核病流行情况及影响因素,为全市耐药结核病防控提供科学依据。方法将2015年9月—2016年6月黄山市结核病专科门诊所有痰涂片阳性的71例肺结核患者纳入本次调查,通过调查问卷了解疾病史以及耐药相关因素;对收治的结核病患者的痰标本进行培养分离菌株,最终将66份痰培养阳性菌株进行菌种鉴定和抗结核药物敏感试验,采取比例法,对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、氧氟沙星(OFX),卡那霉素(KM)六种抗结核药物敏感性进行药物敏感性试验。结果 66份痰标本菌种鉴定中,5例属于非肺结核分支杆菌,最终61例纳入统计。黄山地区总耐药率和耐多药率分别21.31%、3.28%;6种抗结核药物的耐药顺位依次为耐SM(13.11%)、耐RFP(8.20%)、耐OFX(8.20%)、耐INH(6.56%)、耐EMB(4.92%)、耐KM(0%)。初复治患者耐药率分别为16.98%、50.00%。复治患者RFP和SM耐药率高于初治患者,差异有统计学意义(P<0.01)。单因素分析由于其他疾病未应用过抗结核药物耐药率低,差异有统计学意义(P<0.05)。结论提高结核病患者一次性治愈率,减少复治患者数量,同时建立快速有效的结核分支杆菌药敏检测体系,合理应用抗生素对黄山市耐药结核病防控工作尤为重要。

Objective To understand the epidemic situation and influencing factors of drug-resistant tuberculosis(TB) inHuang Shan City, so as to provide the evidence for the prevention and control of drug-resistant TB in the city. Methods Atotal of 71 TB patients with positive sputum smears were enrolled in this survey in Huangshan TB Specialist Clinic fromSeptember 2015 to June 2016. The bacterial identification and antituberculosis drug susceptibility test were carried out. Thedrug susceptibility test was carried out for six antituberculosis drugs, including isoniazid(INH), rifampicin(RFP), ethambutol(EMB), streptomycin(SM), ofloxacin(OFX), and kanamycin(KM). Results Totally 66 strains of sputum samples wereidentified, 5 belonged to nontuberculous mycobacteria, and the final 61 were included in the statistics. The total drug resistancerate and multi drug resistance(MDR) rate were 21.31% and 3.28% respectively in Huang Shan area, and the order of drugresistance was SM(13.11%), RFP(8.20%), OFX(8.20%), INH(6.56%), EMB(4.92%) and KM(0%). The drug resistance ratesof initial treatment patients and retreatment patients were 16.98% and 50.00% respectively. The resistance rates of RFP andSM in retreatment patients were higher than those in newly diagnosed patients(P<0.01). The univariate analysis showed that theresistance rate of antituberculosis drugs in the patients who were not treated with antituberculosis drugs because of otherdiseases was lower than that in other patients(P<0.05). Conclusion It is the key to improve the one-time cure rate of TBpatients, reduce the number of retreatment patients, establish a rapid and effective drug sensitivity detection system for Mycobacterium tuberculosis, and rationally apply antibiotics for the prevention and control of drug-resistant TB in Huangshan.