158例涂阴培阳肺结核患者分离菌株耐药情况分析

Drug resistance analysis of 158 isolated strains from patients with smear-negative and culture-positive tuberculosis

目的了解湖北省涂阴培阳肺结核患者分离菌株耐药水平，为有效控制耐药结核病提供依据。方法采用WHO推荐的比例法，对湖北省内的4个国家级耐药监测点2013年获得的158例涂阴培阳患者的临床分离株进行药物敏感性试验（简称“药敏试验”），其中一线抗结核药物有异烟肼（H）、利福平（R）、链霉素（S）、乙胺丁醇（E）4种；二线抗结核药物有卡那霉素（Km）、卷曲霉素（Cm）、氧氟沙星（Ofx）、对氨基水杨酸（PAS）、丙硫异烟胺（Pto）5种。采用Excel建立数据库，采用SPSS16．0统计学软件进行分析，对耐药率的比较采用卡方检验，P〈0．05为差异有统计学意义。结果分离的158株菌株总体耐药率为18．99％（30／158），耐多药率为1．90％（3／158），一线药物S的耐药率最高为13．29％（21／158），二线药物Cm的耐药率最高为3．80％（6／158）。9种药物耐药率由高到低的顺位分别为S13．29％（21／158）、H9．49％（15／158）、Cm3．80％（6／158）、R3．16％（5／158）、PAS2．53％（4／158）、Km1.90％（3／158）、E1．27％（2／158）、Ofx1．27％（2／158）、Pto0．63％（1／158）。9种药物均出现了耐药菌株，共出现了15种不同耐药形式。4种一线药物耐药率为15．82％，与湖北省1999年耐药监测4种一线药物初始耐药率17．5％比较基本持平，差异无统计学意义（X^2=0．25，P〉0．05）。结论涂阴培阳肺结核患者分离株有较高的耐药率，应引起重视，加强监测，进行规范治疗和管理。

Objective To understand the drug-resistant level of strains isolated from patients with smear-ne- gative and culture-positive tuberculosis （TB） in Hubei, and to provide basis for effectively control drug-resistam TB. Methods Proportion method recommended by World Health Organization （WHO） was applied. Drug susceptibility test （DST） of H, R, S, E （the first-line anti-TB drugs） and Kin, Cm, Ofx, PAS, Pto （the second-line anti-TB drugs） for 158 isolated strains from patients with smear-negative and culture-positive TB from 4 national drug-re- sistance monitoring sites in Huhei in 2013 was conducted. Database was established using Excel. Statistical analysis was performed with SPSS 16.0. Chi-square test was used to test drug-resistance rate with P〈0.05 as statistically significant difference. Results The overall drug-resistance rate of 158 strains was 18. 99% （30/158）, and the multi-drug resistant rate was 1.90% （3/158）. Specifically, the drug-resistance rates of S and Cm were 13.29% （21/158） and 3.80% （6/158）, which were respectively the highest among the first line and the second line drugs. Moreover,the drug-resistance rates of 9 drugs from high to low were S 13.29% （21/158）, H 9.49% （15/158）, Cm 3.80% （6/158）, R 3.16% （5/158）, PAS 2.53% （4/158）, Km 1.90% （3/158）, E 1.27% （2/158）, Ofx 1.27% （2/158） and Pto 0.63% （1/158）. Drug-resistant strains appeared to 9 drugs, and there were a total of 15 different forms of resistance. All in all, the drug-resistance rate of 4 kinds of first-line drugs was 15.82%, which kept basi- cally balance with the monitoring data 17.5% in Hubei in 1999 （X^2 =0. 25, P〉0.05）. Conclusion The drug resistance rates of the isolated strains from patients with smear-negative and culture-positive TB are higher, which should be paid attention to, we should strengthen surveillance, and standardize treatment and management as well.