初治菌阳肺结核患者异烟肼和利福平原发耐药调查

Primary drug resistance of isoniazide and rifampicin in initial-treated bacterial positive patients with pulmonary tuberculosis

目的分析我院近年来不同年龄段初治肺结核痰结核分枝杆菌原发耐药情况,为进一步制定结核病控制策略提供参考依据。方法根据年龄将572例肺结核患者分为10-19岁,20-29岁,30-39岁,40-49岁及50岁以上共5组,采用绝对浓度法进行抗结核药物耐药性测定。了解原发耐药的趋势变化。结果10-19岁,20-29岁,30-39岁,40-49岁和50岁以上各年龄组异烟肼耐药率分别为10.00%,8.43%,9.68%,7.95%和12.68%;利福平耐药率分别为2.50%,6.02%,4.84%,4.55%和4.23%,异烟肼和利福平同时耐药分别为2.50%,4.82%,3.23%,3.41%和2.82%,各组间无显著性差异(P>0.05)。异烟肼原发性耐药率9.27%(53/572)显著高于利福平原发性耐药率5.07%(29/572)(P=0.0059)。所有患者两种药物同时耐药的耐药率为3.85%。2012年到2014年原发耐药均呈逐年降低趋势,2015年有所升高,但均无显著性差异(P>0.05)。结论近年来,异烟肼和利福平的原发耐药率呈下降趋势,但不容忽视。异烟肼原发性耐药率显著高于利福平。此外,异烟肼在老年组耐药率最高,利福平在年轻组最高,异烟肼和利福平同时耐药在年轻组较高。

Objective To analyze the drug resistance of mycobacterium tuberculosis among different age groups in recent years, in order to provide reference frame for further development of mycobacterium tuberculosis con- trol policy. Methods 572 patients with pulmonary tuberculosis were divided into five groups, including 10-19 years, 20-29 years, 30-39 years, 40-49 years and over 50 years old groups. All of the strains of mycobacterium tu- berculosis were tested for resistance to INH and RFP, respectively, by the absolute concentration method. Results The rate of primary drug resistance for the above five groups was 10. 00%, 8.43%, 9. 68%, 7.95% and 12. 68%, respectively, when tested by INH, and 2. 50%, 6.02%, 4. 84%, 4. 55% and 4. 23%, respectively, tested by RFP. There was no significant differences among the 5 groups （P 〉 0. 05）. The rate of primary INH and RFP resist- ance was 2. 50%, 4. 82%, 3.23%, 3.41% and 2. 82%, respectively. For all enclosed 572 patients, the rate of primary INH-drug resistance was 9. 27%, which was higher than that of primary RFP-drug resistance of 5.07%. Fur- thermore, the rate of primary INH and RFP resistance was 3.85%. Conclusion INH and RFP drug primary resist- ance has reduced in recent years but can not be ignored. INH drug primary resistance is significantly higher than RFP. Furthermore, [NH-drug resistance is the highest in older age groups, and RFP or RFP and INH resistance is the highest in youth groups.