重庆市耐多药结核病患者广泛耐药和广泛耐药前期发生情况分析

Situation analysis of XDR and Pre-XDR-TB among MDR-TB patients in Chongqing

【摘要】目的了解重庆地区耐多药结核病（MDR-TB）患者中广泛耐药结核病（XDR-TB）和广泛耐药结核病前期（Pre—XDR-TB）的发生情况，为制定适合本地区的MDRTB控制策略提供参考和依据。方法对2014年7月至2015年12月重庆市39个区（县）结核病防治机构收治的435例可疑MDR-TB患者涂阳痰标本临床分离株进行菌种鉴定和一、二线抗结核药物敏感性检测，对最终确诊的101例MDR-TB患者进行二线抗结核药物耐药状况的分析。结果101例MDRTB患者中，发生XDRTB和Pre-XDR-TB共计44例（43．6％，44／101），其中XDR-TB患者11例（10．9％），Pre-XDRTB患者33例（32．7％）。各登记分类中复治失败患者的XDR-TB及Pre—XDR-TB总发生率最高，为61．5％（8／13）。101例MDRTB患者对6种二线抗结核药物（卡那霉素、氧氟沙星、卷曲霉素、乙硫异烟胺、对氨基水杨酸、阿米卡星）的总耐药率为49．5％（50／101）；对6种二线抗结核药物的耐药性表现出15种耐药组合类型，各耐药组合类型中除同时对6种二线抗结核药物均敏感的类型外（50．5％0，51／101），以Pre-XDR-TB患者中对氧氟沙星的耐药率最高（22．8％，23／101）。结论重庆地区MDR—TB患者中XDR-TB和Pre-XDR-TB的发生率较高，对氧氟沙星的耐药情况严重；应加强对MDRTB患者的耐药性监测，防止Pre-XDR-TB甚至XDR-TB的产生。

Objective To understand the situation of extensively drug-resistant tuberculosis （XDR-TB） and pre-extensively drug-resistant tuberculosis （Pre-XDRTB） in patients with multidrug-resistant tuberculosis （MDR-TB） in Chongqing, so as to provide the scientific evidences for development of strategy on MDR-TB control in Chongqing. Methods By using P-Nitro benzoic acid （PNB）/2 Thiophene carborylie acid hydrazide （TCH） method, the strain identification of Mycobacterium tuberculosis clinical isolated strains getting from smear-positive sputum specimens of 435 MDR-TB suspects, who were detected in 39 district or county TB dispensaries of Chongqing from July 2014 to December 2015, was performed. At the same time, the drug susceptibility testing to all four first-line anti-TB drugs and six second-line anti-TB drugs was also done by using proportion method. Final- ly, 101 patients were confirmed as MDR-TB cases and their drug resistance results to second-line anti-TB drugs were analyzed. Results The overall proportion of XDRTB and Pre-XDR-TB cases among 101 MDRTB cases was 43.6% （44/101）, and the proportion of XDR-TB cases and Pre-XDR-TB cases was 10.9% （11/101） and 32.7% （33/101） respectively. Among the different registration category MDR-TB cases, the overall proportion of XDR-TB and Pre-XDR-TB was higher （61.5%, 8/13） in retreatment failure patients. Among 101 MDR-TB patients, 51 cases （50. 5%, 51/101） were sensitive to all 6 second-line anti-TB drngs（ofloxacin, kanamycin, capreomycin, ethio- namide, p-aminosalicylic acid, amikacin） while 50 cases （49.50/0, 50/101） were resistant to at least one of the 6 anti-TB drugs. There were 15 types of individual or combined drug-resistance to those 6 second-line drugs, and the proportion of Pre-XDR-TB cases with ofloxacin-resistance was the highest one in 15 types of drug-resistance, accounting for 22.8% （23/101）. Conelusion The proportion of XDR-TB and Pre-XDR-TB among MDR TB pa-tients are high in Chongqing. The ofloxacin-resistance is in a serious situation. Drug-resistance monitoring among MDR-TB patients should be strengthened and MDRTB detection and treatment should be improved, so as to pre- vent the development of Pre-XDR-TB or even XDR-TB from MDR-TB.