自贡市肺结核分枝杆菌对一线抗结核药物耐药性分析

Analysis on drug resistance of Mycobacterium tuberculosis to the first-line anti tuberculosis drugs in Zigong city

目的了解自贡市肺结核分枝杆菌对一线抗结核药物的耐药状况,为结核病防控工作提供参考依据。方法收集2010-2014年自贡市结核病防治所及各区县结核病防治机构肺结核患者样本分离培养获得的结核分枝菌株及其患者背景资料,采用比例法对一线抗结核药物异烟肼(H)、链霉素(S)、利福平(R)、乙胺丁醇(E)进行药物敏感性体外试验,分析耐药结果。结果 2010-2014年共获得结核分枝杆菌临床分离菌株1 239株,药物敏感性试验结果显示总耐药率为27.85%(345/1 239),其中初治患者菌株耐药率为24.98%(283/1 133),复治患者菌株耐药率为58.49%(62/106);历年耐药率分别为21.88%、24.79%、31.31%、29.63%、26.98%。对4种抗结核药物H、S、R、E的耐药率分别为20.34%(252/1 239)、17.27%(214/1 239)、16.55%(205/1 239)、8.96%(111/1 239)。总耐多药率为14.53%(180/1 239),其中初治患者菌株耐多药率为11.92%(135/1 133),复治患者菌株耐多药率为42.45%(45/106)。耐2种药耐药率为6.13%(76/1 239),耐3种及以上耐药率为11.78%(146/1 239)。结论自贡市结核分枝杆菌耐多药率均高于全国平均水平,应加强耐药结核病监测和防治,控制耐药结核病的蔓延。

Objective To analyze the drug resistance of Mycobacterium tuberculosis（MTB）to the first-line drugs in Zigong City,and to provide the reference for the control and treatment of drug-resistant tuberculosis（TB）. Methods All clinical MTB strains isolated from patients with TB were collected from institutions for TB control and treatment in Zigong city from Apr.2010 to Aug.2011 and drug susceptibility testing（DST）were performed in a proportional manner to 4first-line drugs（INH,SM,RFP,and EMB）in vitro.Patient＇s clinical data were also retrieved and analyzed. Results A total of 1 239 MTB clinical isolates were collected and tested with the overall drug-resistant（DR）rate of 27.85%（345/1 239）.The DR rates of patients with initial TB and recurrent TB were 24.98%（283/1 133）and 58.49%（62/106）,respectively,and the annual DR rates were 21.88%（2010）,24.79%（2011）,31.31%（2012）,29.63%（2013）and 26.98%（2014）,respectively.The drug resistant rates to INH,SM,RFP,and EMB were 20.34%（252/1 239）,17.27%（214/1 239）,16.55%（205/1 239）,and 8.96%（111/1 239）.For multiple drug resistance（MDR）,the total average rate was 14.53%（180/1 239）.The MDR rate of the initial and retreatment tuberculosis patients was11.92%（135/1 133）and 42.45%（45/106）.The overall multi-drug resistance rate was 14.53% with 6.13%to two drugs and 11.78%to three or more drugs. Conclusions The multi-drug resistance rate is higher than that of national average,therefore,the surveillance,control and treatment for drug resistant TB should be enhanced to prevent the spread of drug resistant tuberculosis.