首次复治涂阳肺结核患者耐药情况分析

Analysis of drug resistance to antituberculosis drugs of smear-positive pulmonary tuberculosis with first retreatment

目的分析首次复治涂阳肺结核患者耐药特点，为临床制定合理的化疗方案及结核病的防治提供依据。方法搜集2014年1月至2015年12月河北省胸科医院收治的首次复治涂阳肺结核患者237例[标准治疗复发组（63例），标准治疗失败组（26例），不规律治疗组（148例）]，收集上述3组患者的晨痰或支气管肺泡灌洗液行BACTECMGIT 960快速培养，然后对链霉素（Sm）、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、对氨基水杨酸异烟肼（Pa）、左氧氟沙星（Lfx）、利福布汀（Rfb）、阿米卡星（Am）8种药物进行药物敏感性试验（简称“药敏试验”），并对其结果进行分析。结果在237例首次复治涂阳肺结核患者中，有107例患者对8种检测药物耐药，任一耐药率为45．1％（107／237），对一线抗结核药物（Sm、INH、RFP、EMB、Rfb）耐药率为41．8％（99／237），对二线抗结核药物（Pa、Lfx、Am）耐药率为24．1％（57／237）；耐多药率为22．4％（53／237），广泛耐药率为1．3％（3／237）。8种检测药物耐药率顺位依次为：RFP（31．2％，74／237）、Sm（30．8％，73／237）、INH（26．6％，63／237）、Rfb（24．1％，57／237）、Pa（15．2％，36／237）、Lfx（11．8％，28／237）、EMB（10．5％，25／237）、Am（6．8％，16／237）。标准治疗失败组任一耐药率[73．1％（19／26）]明显高于标准治疗复发组[50．8％（32／63）]和不规律治疗组[37．8％（56／148）]，差异有统计学意义（χ2=12．19，P〈0．05）。结论我院收治的首次复治涂阳肺结核患者对任一抗结核药物耐药率高，特别是对一线抗结核药物耐药率高，耐多药肺结核所占比率较高，不同复治类型耐药率不同。

Objective To analyze the drug-resistant characteristics for smear positive tuberculosis patients with first-time retreatment, in order to provide evidence for the prevention and treatment of tuberculosis and help in the clinical formulation of reasonable chemotherapy. Methods We collected 237 smear positive tuberculosis pa- tients with first-time retreatment in Hebei Chest Hospital between January 2014 and December 2015 （including 63 patients in standard treatment relapse group, 26 patients in standard treatment failure group, and 148 patients in the irregular treatment group）. We collected morning sputum or Bronchoalveolar lavage fluid from all patients and used BACTEC MGIT 960 for rapid culture. Then we used 8 drugs of Streptomycin （Sin）, Isoniazid （INH）, Rifampiein （RFP）, Ethambutol （EMB）, Isoniazid of aminosalicylic acid （Pa）, Levofloxacin （Lfx）, Rifabutin （Rfb） and Ami- kacin （Am） for the drug susceptibility testing, and analyzed the results. Results Among the 237 smear positive tuberculosis patients with first-time retreatment, 107 patients were detected as resistant to the 8 antituberculosis drugs. Any drug resistant rate is 45.1% （107/237）; first-line drug （Sin, INH, RFP, EMB, Rfb） resistant rate is 41.8% （99/237）; second-line drug （Pa, Lfx, Am） resistant rate is 24.1% （57/237）; multidrug-resistant rate （MDR） is 22.4% （53/237） and the extensively drug resistant （XDR） rate is 1.3% （3/237）. with the drug-resis- tant rates from high to low, the 8 antitubereulosis drugs were RFP （31.2%, 74/237）, Sm （30.8%, 73/237）, INH （26.6%, 63/237）, Rfb （24.1%, 57/237）, Pa （15.2%, 36/237）, Lfx （11.8%, 28/237）, EMB （10.5%, 25/237）, and Am （6.8%, 16/237）, respectively. The any-drug resistant rate in standard treatment failure group [73. 1 %, （19/26）] was significantly higher than the standard treatment relapse group[50. 8%, （32/63）] and the irregular treatment group [37.8%, （56/148）]. The differences were statistically significant （χ2= 12.19, P〈0. 05）. Conclusion The any-drug resistant rate was high in the smear positive tuberculosis patients with first-time retreatment in our hospital, especially for the first-line antituberculosis drugs. The XDR-TB constituted a larger proportion. Drug resistant rates were different for different retreatment types.