分枝杆菌感染特征与结核分枝杆菌耐药性分析

Analysis of the characteristics of the regional distribution of Mycobacterium tuberculosis and nontuberculous mycobacteria and their drug resistance

目的了解本地分枝杆菌感染状况和结核分枝杆菌耐药情况。方法采集来自山东省8县市区的8 000例疑似结核病患者临床标本,采用抗酸染色、罗氏培养基培养、荧光定量PCR对结核分枝杆菌与非结核分枝杆菌进行鉴定,分析其地区分布、年龄及性别特征;用绝对浓度法进行药敏试验分析其耐药性。结果 8 000例疑似患者中,确诊为分枝杆菌感染和经抗痨治疗康复的疑似患者为7 068例;临床标本分枝杆菌培养阳性3 687例,对3 655株分枝杆菌作菌种鉴定和药敏试验,属非结核杆菌25株,结核杆菌3 630株;患者年龄主要集中在20~39岁（3433例）,60~79岁年龄段存在一个次级峰（2176例）;患者男、女性别比约为3︰1;耐药例数逐年增多（共624例）,地级市各年份的耐药例数均多于其他县市;4种一线药物中耐INH、SM、EMB与RPF的例数分别占总耐药例数的30.45%、30.45%、2.40%与16.99%;对以上4种药物中耐2种及以上的合计耐药率占19.71%,其中耐2药80株,耐3药31株,全耐药12株。结论抽样地区分枝杆菌感染患者数及耐药患者数呈增多趋势,结核菌耐药情况依然严重。

Objectives To investigate the characteristics of the regional distribution of Mycobacterium tuberculosis and nontuberculous mycobacteria over the past three years and to analyze their drug resistance. Methods Eight counties in Shandong Province were randomly sampled and specimens were collected from 8 000 individuals suspected of having tuberculosis from January 2011 to December 2013.Acid fast staining,culturing in Lowenstein-Jensen medium,and real-time quantitative PCR were used to identify M.tuberculosis and nontuberculous mycobacteria.Characteristics of the regional distribution of the bacteria and the age and sex of individuals with tuberculosis were analyzed.The absolute concentration method was used to detect the drug sensitivity of mycobacteria. Results Of 8 000 patients suspected of having tuberculosis,7 068 were diagnosed with tuberculosis.Specimens from 3 687 patients were positive for culturing of mycobacteria.After mycobacterial species were identified,3 655 strains were used in drug sensitivity testing.Of these,25 were strains of nontuberculous mycobacteria and 3 630 were strains of M.tuberculosis.Patients were mainly concentrated in two age groups,those ages 20-40（3 433patients）and those ages 60-80（2 176patients）.The proportion of infected males to females was close to 3：1.Cases of individuals with drug-resistant mycobacteria,and particularly combined resistance,had increased.The number of cases of drug resistance increased yearly（624cases in total）,and cases of drug resistance were more prevalent in cities than in counties in each year studied.Drug resistance to four first-line drugs（INH,SM,EMB,and RPF）was 30.45%,30.45%,2.40%,and 16.99%,respectively.Combined resistance to 2or more drugs was19.71%.Eighty strains were resistant to 2drugs,31 strains were resistant to 3drugs,and 12 strains were resistant to all 4drugs. Conclusion In the sampled area,the number of cases of mycobacterial infections and the drug resistance of those mycobacteria have increased.These findings have laid the basis for further exploration of the regional treatment and individualized treatment of mycobacterial infections.