三种利福霉素类抗痨药物耐药状况对比分析

A comparative analysis on drug reistant status of three rifamycin-type anti-tuberculosis drugs

目的探讨三种利福霉素类抗痨药物的耐药状况。方法采用鸡蛋固体培养基对168例肺结核患者进行痰结核菌培养,对培养阳性菌株采用绝对浓度间接法对国产利福平、进口利福平及利福喷丁进行耐药检测,以50μg/ml为耐药界限。结果共获得结核分支杆菌54株,其中耐国产利福平者31株,耐进口利福平者36株,耐利喷丁者10株,耐药率分别为57.4%,66.7%和18.5%。利福喷丁耐药率明显低于国产利福平(χ2=17.3382,P<0.0001)和进口利福平(χ2=25.5989,P<0.0001),而国产利福平和进口利福平耐药率无差别(χ2=0.9829,P>0.05)。结论国产利福平和进口利福平耐药状况均非常严重,因此,在临床用药过程中,对国产利福平耐药者不宜以进口利福平代替,而应以利福喷丁替代以保证疗效。

Objective To inquire the resistant status of three rifamycin type anti tuberculosis drugs. Methods The sputa obtained from 168 pulmonary tuberculosis patients was cultured on egg solid culture medium, then the positive strains were tested for resistance to Chinese made rifampin (RFP), imported rifampin and rifapentine (RFT) by the absolute concentration indirect method, the drug resistant limit was 50μg/ml. Results 54 mycobacterium tuberculosis strains were obtained, among them, strains resistant to Chinese made RFP, imported RFP and RFT were 31,36 and 10, respectively, accordingly, the rug resistant rates were 57.4%, 66.7%and 18.5%. The rate of drug resistance to RFT was obviously lower than that of Chinese made RFP (χ2=17.3382,P<0.0001) and imported RFP (χ2=25.5989,P<0.0001), but there was no marked difference between Chinese made RFP and imported RFP (χ2=0.9829,P>0.05). Conlusion Thedrug resistant status of Chinese made RFP and imported RFP was very serious, so, in clinic, if Chinese made RFP resistance in some patients developed, it is not right to replace Chinese made RFP with imported RFP, whereas RFT should be used.