楚雄州结核分枝杆菌抗结核药物耐药性分析

Resistance analysis of Mycobacterium tuberculosis in Chuxiong Yi Autonomous Prefecture

目的研究楚雄州肺结核患者痰标本中结核分枝杆菌的耐药情况和变化规律,为制定结核病防治方案提供技术依据。方法收集2011年-2015年楚雄州辖区10县(市)疾控机构从肺结核患者痰标本中培养出的分枝杆菌,对其进行菌型鉴定及抗结核药物敏感性试验。结果收集并经鉴定为分枝杆菌的菌株共839株,其中人型占92.85%,牛型占2.14%,NTM占5.01%;各药物耐药率:INH为11.80%,RFP为7.51%,SM为12.28%,EMB为4.05%,KN为5.36%,OFX为5.36%;不同耐药类型耐药率:总体耐药率为23.72%,单耐药率为12.63%,耐多药率(MDR-TB)为5.24%,多耐药率为5.84%,广泛耐药率(XDR-TB)为1.19%,耐二线药率为1.67%。结论楚雄州引起肺结核病变的分枝杆菌主要以人型为主,NTM虽然所占比例较小,但耐药率较高;楚雄州广泛耐药率(XDR-TB)高于全国平均水平;楚雄州分枝杆菌耐药性与患者的性别、年龄、民族及职业关系不大;楚雄市结核病总体耐药率及耐多药率高于全州平均水平。

Objective To investigate the drug resistance and variation of Mycobacterium tuberculosis（ M.tuberculosis） in sputum specimen of tuberculosis（ TB） patients in Chuxiong,so as to provide technical basis for developing TB control programs.Methods M.tuberculosis was collected from sputum specimen of TB patients in CDCs distributing in 10 counties（ or areas） of Chuixong during 2011-2015,so as to identify its type and perform sensitivity test of anti-tuberculosis drugs.Results A total of 839 strains of M.tuberculosis were identified,with 92.85% for human type,2.14% for cattle type and 5.01% for NTM; the rates of drug resistance were 11.80% for INH,7.51% for RFP,12.28% for SM,4.05% for EMB,5.36% for KN and5.36% for OFX,respectively.Moreover,the resistance rates of different resistance types were 23.72% for overall resistance rate,12.63% for single resistance rate,5.24% for MDR-TB,5.84% for multi-resistance,1.19% for XDR-TB,and1.67% for second-line resistance.Conclusion The pulmonary lesions were mainly caused by human type M.tuberculosis in Chuxiong,the proportion for NTM was low,even though,the drug resistance rate was significantly high.Importantly,XDR-TB was higher than the national average level,and there was no marked association between sexes,ages,nations,professions and the drug resistance of M.tuberculosis.Finally,the overall resistance rate and MDR-TB were significantly higher than average level of Chuxiong.