天津市城区肺结核患者对吡嗪酰胺耐药的现状及特征

Prevalence and characteristic of Pyrazinamide resistance among pulmonary tuberculosis patients in urban area in Tianjin

目的了解天津市城区肺结核患者对吡嗪酰胺（PZA）耐药的现状及特征。方法应用Bactec MGIT 960系统，对2011-2013年天津市结核病控制中心门诊部确诊的痰培养阳性肺结核患者进行一线抗结核药物的药敏试验，以812例有药物敏感性试验（简称“药敏试验”）结果的患者为研究对象，分析PZA耐药情况。结果初治肺结核患者PZA耐药率为2．8％（20／706），复治患者为7．5％（8／106），差异有统计学意义（χ^2=6．15，P=0．01）。MDR-TB患者的PZA耐药率为32．0％（16／50），高于非MDR-TB患者的1．6％（12／762）（χ^2=130．46，P〈0．01）。INH、RFP、EMB、Sm耐药和敏感患者的PZA耐药率分别为18．7％（26／139）、0．3％（2／673）、32．7％（17／52）、1．4％（11／760）和60．9％（14／23）、1．8％（14／789）、14．8％（18／122）、1．4％（10／690），差异均有统计学意义（χ^2值分别为117．25、142．71、234．40和55．12，P值均〈0.01）。经多因素分析，外地人口（Waldz χ^2=6．31，P=0．01，OR=5．02，95％CI=1．43～17．68）、INH耐药（Waldy χ^2=10．90，P〈0．01，OR=18．25，95％CI=3．26～102．26）、RFP耐药（Waldy χ^2=3．76，P=0．05，OR=3．28，95％CI=0．99～10．91）、EMB耐药（Waldz χ^2=22．87，P〈0.01，OR=24．60，95％CI=6．62～91．41）是PZA耐药危险因素。结论PZA耐药与其他一线药耐药性有关联，PZA耐药率在MDR患者中较高，应重视对MDR-TB患者进行PZA药敏试验。

Objective To understand the prevalence and characteristics of Pyrazinamide （PZA） resistance among pulmonary tuberculosis （PTB） patients in urban area in Tianjiru Methods Bactec MGIT 960 system was used to test the susceptibility of first line anti-TB drugs for culture positive PTB patients diagnosed in clinic department of Tianjin Center for TB Control during 2011 to 2013. Eight hundred and twelve patients with drug susceptibility test results were enrolled to analyze the prevalence and characteristics of PZA resistance. Results Among new patients 2. 8% （20/706） were resistant to PZA compared to 7.5% （8/106） among previously treated patients （χ^22 =6.15, P〈0.05）, and the difference was statistically significant （χ^2 =6.15, P=0. 01）. Among MDR-TB patients 32.0% （16/50） were resistant to PZA, which was significantly higher than 1.6% （12/762） among non MDR-TB patients （χ^2= 130. 46, P%0.01）. Among patients with and without INH resistance, RFP resistance, EMB resistance and Sm resistance, the proportions of PZA resistance were respectively 18. 7% （26/139） vs 0.3% （2/673）, 32.7% （17/52） vs 1.4% （11/760）, 60.9%（14/23）vs 1.8% （14/789） and 14.8% （18/122） vs 1.4%（10/690）, and the differences were statistically significant （Z2 were respectively 117.25, 142.71, 234. 40 and 55.12, P〈0.01）. In multivariate analysis, migrants （Wald χ^2 = 6.31, P = 0. 01, OR = 5.02,95 % CI = 1.43- 17.68）, resistances to INH（Wald χ^2 = 10.90, P〈0. 01, OR= 18. 25, 95%CI= 3.26-102.26）, resistance to RFP （Wald χ^2=3.76, P=0.05, OR=3.28, 95%CI=0.99-10.91） and resistance to EMB （Wald χ^2 =22.87, P〈0.01, OR=24.60, 95%CI=6.62-91.41） were risk factors to PZA resistance. Conclusion PZA resistance has relation to resistance to other first line anti-TB drugs, and proportion of PZA resistance was significant higher among MDR-TB patients, which emphasizes the importance to test susceptibility of PZA among MDR-TB patients.