涂阳肺结核患者243例耐药特征分析

Drug resistance analysis in 243 patients with sputum smear-positive pulmonary tuberculosis

目的分析243例涂阳肺结核患者的耐药情况,为制定合理的耐药结核病治疗方案提供科学依据。方法选取2016年1—12月安徽省胸科医院收治的243例涂阳肺结核患者。经痰分离培养并进行10种抗结核药物(异烟肼、利福平、链霉素、乙胺丁醇、左氧氟沙星、阿米卡星、卷曲霉素、丙硫异烟胺、对氨基水杨酸钠以及利福喷丁)的药物敏感性试验,对其结果进行分析。结果所有患者的任一耐药率为41. 6%(101/243)。复治患者任一耐药、耐多药、对一线抗结核药物耐药及对二线抗结核药物耐药的比率高于初治患者[68. 7%(68/99)比22. 9%(33/144)、33. 3%(33/99)比2. 8%(4/144)、63. 6%(63/99)比14. 6%(21/144)、63. 6%(63/99)比18. 1%(26/144)],差异均有统计学意义(均P <0. 001)。耐一线抗结核药物患者84例,其中耐多药患者37例,耐药率由高到低依次为利福平>链霉素>异烟肼>乙胺丁醇。耐二线抗结核药物患者89例,对各药的耐药率由高到低依次为利福喷丁>丙硫异烟胺=左氧氟沙星>阿米卡星>卷曲霉素>对氨基水杨酸钠。结论结核病尤其是耐药结核病形势不容乐观,乙胺丁醇、卷曲霉素、阿米卡星、对氨基水杨酸钠仍有很大的临床抗结核价值,应注意复治肺结核方案的合理制定,遏制耐药结核病流行。

Objective To analyze the drug resistance of sputum smear-positive pulmonary tuberculosis in 243 patients and provide scientific evidence for reasonable treatment of drug-resistant tuberculosis. Methods From January to December 2016, 243 patients with sputum smear-positive pulmonary tuberculosis were enrolled at Anhui Chest Hospital. Drug sensitivity tests of 10 anti-tuberculosis drugs(isoniazid, rifampicin, streptomycin, ethambutol, levofloxacin, amikacin, capreomycin, protionamide, sodium aminosalicylate and rifametine) were conducted after sputum separation and culture. Results of drug resistance were analyzed. Results Drug resistance rate of all patients was 41.6%(101/243). Rates of drug resistance, multi-drug resistance, first-line anti-tuberculosis drug resistance and second-line anti-tuberculosis drug resistance in retreated patients were higher than those in newly diagnosed patients[68.7%(68/99) vs 22.9%(33/144), 33.3%(33/99) vs 2.8%(4/144), 63.6%(63/99) vs 14.6%(21/144), 63.6%(63/99) vs 18.1%(26/144)](all P<0.001). Eighty-four patients were resistant to first-line anti-tuberculosis drugs, among them 37 patients presented multi-drug resistance;the order of resistance rates was rifampicin>streptomycin>isoniazid>ethambutol. Eighty-nine patients were resistant to second-line anti-tuberculosis drugs;the order of resistance rates was rifapentine>protionamide=levofloxacin>amikacin>capreomycin>sodium aminosalicylate. Conclusion Tuberculosis, especially drug-resistant tuberculosis is a big clinical problem;ethambutol, capreomycin, amikacin and sodium aminosalicylate show significant anti-tuberculous values;the drug resistance situation of retreatment of tuberculosis is severe.