合并糖尿病耐多药肺结核患者对二线抗结核药物的耐药状况及因素分析

Analysis on drug resistance to second-line anti-tuberculosis drugs and related factors in patients with multi drug resistant pulmonary tuberculosis complicated with diabetes mellitus

目的分析合并糖尿病的耐多药肺结核（MDR-TB）患者对二线抗结核药物的耐药情况及耐药因素,为该类患者制定可靠的化疗方案提供依据。方法将2006年1月—2014年4月宜昌市定点医院住院确诊合并糖尿病的MDR-TB 107例患者,按照血糖控制值范围高低分为A（〈7.0 mmol/L）、B（7~14 mmol/L）、C（〉14 mmol/L）3组,对所有病例的痰标本菌株进行6种二线抗结核药物敏感性检测。结果所有病例的痰标本所分离菌株中87.9%对所检测的6种二线抗结核药物中任1种具有耐药性,其中对氨水杨酸钠（PAS）为二线抗结核单药耐药率最高,达36.4%;对每种单药的耐药率比较显示,C组明显高于A、B两组;对耐2种及2种以上药的耐药率比较,A与B组比较,差异有统计学意义（χ2=4.126,P〈0.05）,C与B组比较,差异有统计学意义（χ2=26.499,P〈0.01）,A与C组比较,差异有统计学意义（χ2=37.391,P〈0.01）。A、B、C 3组中严重耐多药结核病（XDR-TB）患者所占比率分别为3.6%、16.7%及48.4%,C组明显高于A、B两组。结论合并糖尿病MDR-TB患者的血糖控制越差,血糖值越高,其分枝杆菌对二线抗结核药物耐药种数越多,耐药率越高,耐药程度越严重。

[Objective]To analyze the drug resistance to second-line anti-tuberculosis drugs and related factors in patients with multi drug resistant pulmonary tuberculosis（MDR-TB） complicated with diabetes mellitus,provide the basis for formulating the reliable chemotherapy regimen for the patients. [Methods]107 patients with MDR-TB complicated with diabetes mellitus,who were treated in the designated hospital of Yichang City from January 2006 to April 2014,were divided into three groups according to their blood glucose level,including group A（blood glucose level was less than or equal to 7.0 mmol/L）,group B（blood glucose level was7-14 mmol/L）and group C（blood glucose level was equal or greater than14 mmol/L）. The sputum strains from all cases were tested the drug sensitivity to 6 kinds of second-line anti TB drug. [Results]87.9% of sputum strains from all cases were resistant to at least one of six second-line anti TB drugs,and the drug resistance rate to sodium aminosalicylate（PAS）was the highest（36.4%）. The drug resistance rate to single drug of group C was significantly higher than that of group A and group B. As for the drug resistance rate to two or more drugs,there was statistically significant difference between group A and group B（χ2=4.126,P〈0.05）,the difference between group C and group B was statistically significant（χ2=26.499,P〈0.01）,and the difference between group C and group A was statistically significant（χ2=37.391,P〈0.01）. The proportion of patients with XDR-TB in group A,group B and group C was respectively 3.6%,16.7% and 48.4%,and the proportion in group C was significantly higher than that in group A and group B.[Conclusion]The patients with MDR-TB complicated with diabetes mellitus,who have the poor glucose control and higher blood glucose level,are prone to get the higher resistance rate and more serious resistance degree,and the Mycobacterium shows resistance to more species of second-line anti TB drug.