深圳市HIV感染者结核分枝杆菌初始耐药谱分析

Analysis of the primary drug resistance of mycobacterium tuberculosis in HIV patients coinfected with tuberculosis in Shenzhen

目的分析深圳市艾滋病病毒(HIV)感染者结核分枝杆菌(MTB)对抗痨药物的耐药性,为HIV/MTB双重感染的临床治疗提供参考依据。方法收集深圳市第三人民医院2012年1月至2012年12月收治的HIV/MTB双重感染患者40例和118例单纯结核病患者的菌株材料,进行菌种分离鉴定,并行抗异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)、氧氟沙星(OFL)、卡那霉素(KAN)的耐药性检测。结果在抗结核药物中,HIV/MTB组初始耐药率最高的药物是INH(37.5%,15/40),而单纯结核组最高的是SM(10.2%,12/118)。在一线抗结核药物中,HIV/MTB组总初始耐药率为47.5%(19/40),明显高于单纯结核组(12.7%,15/118)。HIV/MTB组INH初始耐药率为37.5%(15/40),SM初始耐药率为27.5%(11/40),初始耐多药率为12.5%(5/40),分别与单纯结核组比较,差异均有统计学意义(P<0.05)。而在二线抗结核药物中,两组初始耐药率差异无统计学意义(P>0.05)。结论深圳市HIV感染者结核分枝杆菌的一线抗结核药物总初始耐药率、耐INH、耐SM、初始耐多药率高,提示临床医师应重视收集HIV感染者和当地耐结核药物资料,关注结核初始耐药问题,以便及时调整治疗方案。

Objective To understand the drug resistance of mycobacterium tuberculosis（MTB） in human immu- nodeficiency virus （HIV） MTB eoinfected patients to guide tuberculosis treatment in Shenzhen. Methods MTB stains were isolated from 40 cases of HIV-MTB coinfected patients and 118 cases of HIV-negative MTB patients admitted to Shenzhen Third People＇s Hospital between January 2012 and December 2012. Isoniazide（INH）, rifampicin （RFP）, streptomycin （SM）, ethambutol （EMB）, ofloxacin （OFL） and kanamycin （KAN） were used in drug resistance test. Results Among the antituberculosis drugs, INH （37.5% ,15/40） was the drug with the highest initial resistance rate in HIV/MTB coinfected patients, while SM （10.2%, 12/118） was the highest one in HIV-nega tive MTB patients. Among the first line antituberculosis drugs, the rate of total initial resistance was higher inHIV/MTB coinfected patients（47.5 %, 19/40） than in HIV-negative MTB patients （ 12.7%, 15/118）. INH resistance （37.5%, 15/40）, SM resistance（37.5%, 15/40） and multi-drug resistance （12.5% ,5/40） to the first-line antituberculosis in HIV/MTB coinfected patients were statistically different from those in HIV negative MTB patients （P〈0.05）. Among the secondline antituberculosis drugs, no statistical difference of initial drug-resistance was found between the two groups （P 〈 0.05）. Conclusions Total initial resistance, INH resistance, SM resistance and multi-drug resistance were high among the first-line antiuberculo sis drugs in HIV/MTB coinfected patients in Shenzhen, which indicated that clinicians should adjust regimen timely based on initial and local drug-resistant data in HIV/MTB coinfected patients.