2012—2015年无锡市活动性肺结核患者一线抗结核药物的耐药特征

Drug-resistant characteristics of first line anti-tuberculosis drugs among patients with active pulmonary tuberculosis in Wuxi City from 2012-2015

目的分析无锡市近年来活动性肺结核患者一线抗结核药物耐药特征,为临床选择治疗方案和防控政策的制定提供依据。方法收集2012—2015年期间送市结核病参比实验室的肺结核患者的痰培养阳性菌株,运用WHO/IUATLD推荐的比例法药敏试验测定结核分枝杆菌分离株对4种常用一线抗结核药的敏感性,对获得的结果进行分析。结果共收集2012—2015年期间无锡市活动性肺结核患者痰培养阳性结核分枝杆菌复合群菌株1 373株,其中1 171株(87.58%)对4种抗结核药物均敏感,166株(12.42%)对1种或1种以上一线抗结核药物药物耐药,单耐药率6.13%,耐多药率5.53%,多耐药率1.27%。4种抗结核药物耐药顺位由高到低依次为利福平(9.65%)、异烟肼(6.96%)、链霉素(2.92%)、乙胺丁醇(1.35%)。滨湖区耐药率和耐多药率高于其他地区。结论无锡市肺结核耐药水平较低,部分地区肺结核患者耐药情况较其他地区严重。需继续做好耐药结核病的监测工作,及时发现并治疗耐药肺结核患者。

[ Objective ] To analyze the drug-resistant characteristics of first line anti-tuberculosis drugs among patients with active pulmonary tuberculosis in Wuxi City, provide the basis for selecting clinical treatment regimens and developing prevention policy. [Methods] The sputum culture-positive strains were collected in municipal tuberculosis reference laboratory from 2012-2015. Proportional method which was recommended by WHO/IUATLD was used to determine the sensitivity to the four first-line anti- tuberculosis drugs and the results were further analyzed. [Results] Totally 1 373 myeobacterium tuberculosis complex strains from patients with active pulmonary tuberculosis were collected during 2012-2015 in Wuxi City. l 171 （87.58%） strains sensitive to all the four anti-tuberculosis drugs, and 166 （12.42%） strains were resistant to at least one drug. The mono drug resistant rate was 6.13%, multi drug resistant rate was 5.53%, and poly-drug resistant rate was 1.27%. The resistant rank of four anti-tuberculosis drugs was rifampicin （9.65%）, isoniazide （6.96%）, streptomycin （2.92%） and ethambutol（1.35%）.Both the multi drug resistant rate and poly-drug resistant rate in Binhu District were higher than those in other districts. [Conclusion] The drug-resistant level of tuberculosis is low in Wuxi City, and tuberculosis patients in some areas have serious drug-resistant status than other areas. It is necessary to continue to improve the surveillance of drug resistant tuberculosis, and early detect and treat the patients with drug resistant tuberculosis.