河南省平顶山市1184株结核分枝杆菌耐药情况分析

Analysis of drug resistance of 1184 Mycobacterium tuberculosis strains in Pingdingshan

目的了解河南省平顶山市耐药结核病的流行现状，为今后本地区结核病防治工作提供依据。方法收集河南省平顶山市结核病防治所于2012年8月至2015年8月发现的1356例（份）涂阳肺结核患者的痰标本，进行结核分枝杆菌培养、菌型鉴定，采用比例法进行6种抗结核药物（H、R、S、E、Ofx、Kin）的药物敏感性试验（简称“药敏试验”）。经鉴定，其中的1184例（株）临床分离株为结核分枝杆菌复合群，对其药敏试验结果进行统计学分析。率的比较采用7。检验，以P＜0．05为差异有统计学意义。结果1184株结核分枝杆菌复合群的总耐药率为34．8％（412／1184），初治患者总耐药率为24．7％（206／834），复治患者为58．9％（206／350），两组间差异有统计学意义（X2=126．77，P=0．000）。总单耐药率为13．7％（162／1184），初治患者单耐药率为12．0％（100／834），复治患者为17．7％（62／350），两组间差异有统计学意义（X2=6．83，P=0．009）。多耐药率为7．9％（94／1184），其中初治患者多耐药率为7．8％（65／834），复治患者为8．3％（29／350），两组间差异无统计学意义（X2=0．08，P=0．775）。总耐多药率为13．2％（156／1184），其中初治患者耐多药率为4．9％（41／834），复治患者为32．9％（115／350），两组间差异有统计学意义（X2=168．26，P=0．000）。结论平顶山地区结核分枝杆菌感染耐药情况不容乐观，尤其是耐多药情况比较严峻，今后应该加强结核病患者的多方位管理，避免或减少耐药结核病的产生。

Objective To understand the epidemic situation of drug resistant tuberculosis （TB） in Pingding- shan city of He＇nan province and to provide evidences for future TB prevention and control work. Methods The sputum samples were collected from 1356 smear positive pulmonary TB patients who were detected in Pingdingshan Institute for Tuberculosis Prevention and Control from August 2012 to August 2015, and then culture, strains identification and drug susceptibility testing （DST） of tubercle bacillus to 6 anti-TB drugs （INH, RFP, Sin, EMB, Ofx, Kin） by using proportion method were performed on all sputum specimens. Of which, Mycobacterium tuberculosis complex strains were identified in sputum of 1184 TB cases and their DST results were analyzed. Chi-square test was used to test for differences in resistant rate between initial treatment patients and retreatment patients. P〈0. 05 was considered as statistically significant. Results The overall drug resistance rate in Mycobacterium tuberculosis complex strains obtained from 1184 TB patients was 34.8% （412/1184）. Of which, the drug resistance rate was 24.7% （206/834） and 58.90/00 （206/350） respectively for initial treatment and retreatment TB patients, and there was statistically significant difference between the two groups （Z2：126.77, P=0. 000）. The mono-resistance rate in all TB patients was 13.7% （162/1184）, and it was 12.0% （100/834） and 17.7% （62/350） respectively for initial treatment and retreatment TB patients. The difference between the two groups was statistically significant （Z2 = 6.83, P=. 009）. The poly-resistance rate in all TB patients was 7.9% （94/1184）, and it was 7.8% （65/834） and 8.3% （29/350） respectively for initial treatment and retreatment TB patients. There was no statistically significant difference between the two groups （X2=0. 08, P=0. 775）. The multidrug-resistance （MDR） rate in all TB patients was 13.2% （156/1184）, and it was 4.9% （41/834） and 32.9% （115/350） respectively for initial treatment and retreatment TB patients. The difference between the two groups was statistically significant （X2= 168.26,P= 0. 000）. Conclusion The situation of drug resistant TB in Pingdingshan is not optimistic, especially the multidrug-resistance situation is grim and the drug resistance pattern is complex： In the future, the patient＇s treatment management should be strengthened to avoid or reduce the generation of drug-resistant TB.