2013年新疆维吾尔自治区博尔塔拉蒙古自治州肺结核患者耐药状况分析

The drugs resistance status of pulmonary tuberculosis patients in Bortala Mongolia Autonomous Prefecture in 2013

目的 了解博尔塔拉蒙古自治州（简称“博州”）肺结核患者的耐药状况。 方法 对博州所辖3个县、市（博乐市、精河县、温泉县）通过普查的方式，将2013年1月1日至2013年12月31日期间发现的所有纳入治疗管理的活动性肺结核患者作为调查对象，共纳入患者358例，其中涂阳肺结核患者192例（初治154例，复治38例），涂阴患者166例。对纳入调查的358例患者均进行了痰培养实验，男225例，女133例，平均年龄（50±20）岁。对其痰标本进行涂片镜检和分离培养，所有培养阳性的患者均进行8种抗结核药物（其中一线抗结核药物4种，分别是INH、RFP、EMB、Sm；二线抗结核药物4种，分别是Ofx、Am、Km、Cm）的药物敏感性试验（简称“药敏试验”）。 采用描述性研究和卡方检验对药敏试验结果进行统计学分析，以P〈0.05为差异有统计学意义。 结果 菌阳患者一线抗结核药物的耐药率为24.60%（46/187），其中初治患者耐药率为22.81%（39/171），复治患者为43.75%（7/16）。耐多药率为8.02%（15/187），其中初治患者为5.26%（9/171），复治患者为37.50%（6/16）。二线抗结核药物的耐药率为5.35%（10/187），其中初治患者耐药率为4.68%（8/171），复治患者为12.50%（2/16）。不同特征肺结核患者分离菌株的耐药率：男性26.13%（29/111），女性26.32%（20/76）；〈30岁年龄组26.19%（11/42），30～岁年龄组27.03%（20/74），≥60岁年龄组25.35%（18/71）（性别和年龄比较的χ^2值分别为0.0005和0.03，P值均〉0.05）。在8种抗结核药物中，耐药率顺位前5位者分别为：Sm［19.79%（37/187）］，INH［14.44%（27/187）］，RFP［10.70%（20/187）］，Ofx［5.35%（10/187）］和EMB［3.21%（6/187）］。 结论 博州总体耐药情况较为严峻，特别要重点关注耐多药疫情发展趋势，建立持续的结核病耐药水平动态监测，为耐多药防治工作提供理论支持。

Objective To investigate the drug resistant status of pulmonary tuberculosis patients in Bortala Mongolia Autonomous Prefecture （hereafter referred as Bozhou）. Methods A total of 358 cases of PTB, including male 225 cases, female 133 cases, with the mean age of （50±20） years old, registered from January 1 to December 31 of 2013 in Bozhou（include Bole city, Jinghe county, Wenquan county） were enrolled in the investigation, among which, 192 cases were smear positive pulmonary tuberculosis patients（154 cases of initial treated patients, 38 cases of retreatment patients）, 166 were smear negative patients. All patients received sputum smear and culture. All culture positive cases recieved eight kinds of drug sensitivity tests（four kinds of the first-line drugs including INH, RFP, EMB, Sm and four kinds of the second-line drugs, including Ofx, Am, Km, Cm）. The descriptive and Chi square test were used for statistical analysis of the drugs susceptible results. P〈0.05 is considered significant difference. Results The first line drug resistant rate of patients with tuberculosis bacillus culture positive was 24.60% （46/187）, this rate for initial treatment patients and retreatment patients was 22.81%（39/171） and 43.75%（7/16） respectively. Multidrug-resistant rate was 8.02%（15/187）, that of the initial treatment patients was 5.26%（9/171） and the retreatment patients was 37.50%（6/16）. The second line drug resistant rate was 5.35%（10/187）,for the initial treatment patients was 4.68%（8/171）and 12.50%（2/16） for the retreatment patients. The drug resistant rate of tuberculosis isolates vary with different characteristics. The drug resistant rate of male, female was 26.13%（29/111）, 26.32%（20/76） respectively, and age below 30 years old group, 30- years old group, above 60 age group was 26.19%（11/42）, 27.03%（20/74）, 25.35%（18/71） （χ^2 values were 0.0005, 0.03, P〉0.05） respectively. The top five resistant drugs of eight kinds of antituberculosis drugs were Sm 19.79% （37/187）, INH 14.44% （27/187）, RFP 10.70% （20/187）, Ofx 5.35% （10/187） and EMB 3.21% （6/187）. Conclusion The overall drug resistance situation of Bozhou is very serious. We should focus on epidemic trend of the multidrug resistant tuberculosis and establish dynamic monitoring of drugs resistant level continuously in order to provide theoretical support for prevention and control of multidrug-resistant tuberculosis.