重庆地区耐多药结核患者抗结核药物敏感性试验特征初步分析

Analysis on the characteristics of anti-tuberculosis drug sensitivity test for multi-drug resistant tuberculosis patients in Chongqing area

目的分析重庆地区耐多药结核病患者抗结核药物的特征,预期为临床药物的选择和耐多药结核病防治规划的完善提供科学依据。方法连续收集重庆市公共卫生医疗救治中心和重庆市第十二人民医院结核内科2013年7月16日至2015年3月11日期间753例临床诊断为耐多药结核病患者的体液标本,采用液体培养法分离培养分枝杆菌,对结核分枝杆菌分离株进行比例法药物敏感性试验,并与全国2007-2008年结核病耐药基线调查结果相比较。采用SPSS 13.0分析软件进行统计学分析,卡方检验以P<0.05为差异具有统计学意义。结果 1.共分离培养出538例分枝杆菌菌株,经鉴定确认结核分枝杆菌有503例,占95.8%(503/538),非结核分枝杆菌有35例。2.503例耐多药结核患者菌株药物敏感性试验结果显示:MDR有428例,XDR有75例。仅对INH和RFP耐药的菌株有34例,仅对一线抗结核药物耐药的菌株有61例,且两种耐药谱在初治与复治分类有显著差异(P值均<0.05)。初治与复治耐多药结核患者在"31-40"和"41-50"年龄组人数分布有显著差异(P<0.05)。EMB耐药率远低于全国2007-2008年结核病耐药基线调查结果。结论重庆地区大部分耐多药结核患者对多数二线抗结核药物耐药,要加强防控,以免进一步发展为广泛耐药患者。对31-50岁左右的初治耐多药结核患者选择用药方案需慎重,以免初治失败。EMB耐药率较低,在重庆地区用于治疗培阳耐多药结核仍有很大的临床抗结核价值,但需予以关注,谨防产生耐药。

Objective To analyze the characteristics of drug-resistant patterns of MDR-TB patients in Chongqing city and to provide reference for selection of clinical drug and improve the control strategy of MDR-TB. Methods 753 cases were selected from January 4, 2014 to March 5, 2015 who were diagnosed with multi-drug re- sistant pulmonary tuberculosis. Isolates were obtained by liquid BD 960. All isolates were tested drug susceptibility by proportion method and the results were compared with that of national survey of drug-resistant tuberculosis in 2007 -2008. Results A total of 538 Mycobacterium were isolated. 503 isolates were confirmed mycobacteria tuberculosis （95.8%, 503/538）, and 35 isolates were non-tuberculosis mycobacteria. Drug susceptibility test showed that 428 cases were MDR-TB and 75 cases were XDR among 503 isolates. 34 cases were only resistant to INI-I and RFP. 61 cases were resistant to first-line drug only. There were significant difference between the two drug-resistant patterns among initial treating and retreating patients （ P 〈 0. 05 respective ）. There was no significant difference between male and female in drug-resistant patterns whether in initial treating or retreating patients （ P 〉 0.05 ）. There were significant difference between initial treating and retreating patients in age groups ‘31 -40＇ and ‘41 -50＇ （P 〈0. 05 respective）. The EMB-resistant rate was far below the results of national survey of drug-resistant tuberculosis in 2007 - 2008. Conclusion Most multi-drug resistant tuberculosis patients in Chongqing are resistant to the second-line drugs. The therapeutic scheme of initial treating MDR tuberculosis patients should be measured to avoid the failure of initial treating. It has great value of EMB in treating culture-positive MDR tuberculosis patients.