116例耐多药肺结核患者二线抗结核药物耐药情况分析

Drug susceptibility of multidrug-resistant Mycobacterium tuberculosis isolated from Ningbo

目的分析宁波地区耐多药结核分枝杆菌对二线抗结核药物的耐药现况,为耐多药结核病的有效防控提供科学依据。方法从宁波市疾病预防控制中心共收集116例耐多药结核分枝杆菌临床分离株,对其进行8种二线抗结核药物左氧氟沙星、氧氟沙星、莫西沙星、卡那霉素、阿米卡星、卷曲霉素、丙硫异烟胺和对氨基水杨酸的敏感性进行检测,分析不同药物耐药率及交叉耐药情况。结果二线抗结核药物中耐药率分别为左氧氟沙星（31.0%）、氧氟沙星（29.3%）、莫西沙星（9.4%）、卡那霉素（8.6%）、阿米卡星（7.8%）、卷曲霉素（3.4%）、丙硫异烟胺（6.0%）和对氨基水杨酸（19.8%）。初治患者对卷曲霉素的耐药率显著高于复治患者（χ^2=4.925,P〈0.05）,此外卡那霉素和阿米卡星之间,氧氟沙星和左氧氟沙星之间存在完全交叉耐药。结论耐多药肺结核患者对二线抗结核药物耐药率较高,且存在广泛耐药结核病例,应开展二线抗结核药物敏感性检测,以便给予合理治疗。

Objective To analyze drug susceptibility of multi-drug resistant（ M DR） Mycobacterium tuberculosis isolated from Ningbo,Zhejiang province,and provide scientific evidence for M DR-tuberculosis（ M DR-TB） control and prevention.Methods A total of 116 MDR-TB isolates were selected from the first drug resistance survey in Ningbo during 2014- 2015.The conventional drug susceptibility test w as conducted to detect the strains＇ drug-resistance to 8 second-line anti-TB drugs（ levofloxacin, ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, protionamide and 4-Amino-2-hydroxybenzoicacid）. The drug-resistant rate and cross resistance w ere analyzed. Results For second-line anti TB drugs,the drug-resistant rates to levofloxacin,ofloxacin,moxifloxacin,kanamycin,amikacin,capreomycin,protionamide and 4-Amino-2-hydroxybenzoicacid w ere 31. 0%,29. 3%,9. 4%,8. 6%,7. 8%,3. 4%,6. 0% and 19. 8%,respectively. The drug-resistant rates to capreomycin in new case group w ere significantly higher than that in re-treated case group（ χ^2= 4. 925,P〈0. 05）. In addition,there w ere the cross-resistances to kanamycin and amikacin,toofloxacin and levofloxacin. Conclusion The resistance rate to second-line anti-TB drugs w as high and extensive drug resistance w as also detected in TB patients in Ningbo,suggesting that it is necessary to conduct the survey of TB strain＇s susceptibility to second line anti TB drugs for the rational treatment of TB.