邯郸市2013年初、复治涂阳肺结核患者耐药状况分析

Analysis of drug resistance in initial and retreated smear- positive tuberculosis patients in Handan city in 2013

目的分析邯郸市初、复治肺结核患者耐药状况,为结核病的临床和控制提供参考依据。方法对邯郸市2013年间登记的348例涂阳肺结核患者痰标本经培养阳性并作菌株鉴定。用比例法对结核分枝杆菌进行抗异烟肼(H)、利福平(R)、链霉素(S)和乙胺丁醇(E)的耐药性检测,并分析结核分枝杆菌的耐药状况。结果 348例结核分枝杆菌感染的涂阳肺结核患者中,总耐药率30.75%,耐多药率14.37%。复治组耐药率及耐多药率均高于初治组,差异有统计学意义(χ2=67.41,χ2=52.11,P<0.01)。对4种抗结核药物的耐药频度由高到低依次为H(42.53%)、S(34.20%)、R(27.59%)、E(20.98%)。初治组对4种抗结核药物的耐药率较复治组低,差异均有统计学意义(P<0.01)。结论邯郸市肺结核患者结核分枝杆菌耐药发生率高,需进一步加强耐药结核病的检测和防控。

Objective To analyze the drug resistance of positive pulmonary tuberculosis （TB） patients registered in Handan and to provide the reference for clinical therapy and control of TB. Methods Sputum culture and strain identification of 348 smear-positive TB patients registered in Handan during 2013 were conducted and the drug susceptibility of the mycobacterium strains to isoniazid （H）, rifampicin （R）, streptomycin （S） and ethambutol （E） were also performed by using proportion method. The data were analyzed with SPSS 17.0 software. Results The total resistance rate and the multi-drug resistance （MDR） rates of myeobaeterium strains from 348 smear-pasitive TB patients infected with myeobaeterium were 30.75% and 14.37% respectively. The total resistance rate and the MDR rate in cases of retreatment group were higher than those in cases of initial treatment group（x2=67.41,x2=52.11,P〈 0.01 ）. The drug resistance rates of mycobaeterium to H,S,R and E were 42.53% ,34.20% ,27.59% and 20.98% ,respectively. The resistance rates for four kinds of anti-TB drugs in initial treatment group were lower than those in retreatment group （P〈 0.01）.Conclusions The drug resistance rate in TB patients in Handan was high. Therefore, effective measures must be taken for deteetion and prevention of drug-resistant TB.