中国西南地区结核分枝杆菌临床分离菌株一线药物耐药状况调查

First-line drug resistance of Mycobacterium tuberculosis isolated in Southwest China

目的了解西南地区结核分枝杆菌临床分离株的耐药表型及其影响因素情况,为结核病的预防和控制提供基础参考数据。方法选取中国西南4个地区(贵州、广西、四川和重庆)2006—2013年从结核病患者痰标本中分离培养的500株结核分枝杆菌,用比例法药物敏感试验对4种一线抗结核药物进行药物敏感性检测,用SPSS22.0中的χ~2检验和Logistic回归进行统计学分析。结果 500株结核分枝杆菌临床分离株,对INH、RFP、EMB和SM的耐药率分别为30.40%、26.00%、9.80%和24.40%,总体耐药率和耐多药率分别是40.60%和27.20%;贵州、四川、广西和重庆的总耐药率和MDR率分别为64.10%和46.15%、59.54%和51.90%、28.88%和14.97%、20.19%和3.85%。χ~2检验结果显示,各地区间菌株对4种药物的耐药率、总体耐药率和耐多药率差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,地区和病例类型是结核病耐药及耐多药发生的影响因素(P<0.05)。结论西南地区,特别是贵州和四川的耐药结核病、尤其是耐多药结核病的流行状况严峻。应加强结核分枝杆菌耐药性监测,以指导临床用药和预防控制耐药结核病的发生和流行。

The drug-resistance and its influencing factors of clinical isolates of Mycobacterium tuberculosis （M. tuberculosis） in Southwest China were investigated in this study, for providing the basic scientific reference for the prevention and control of tuberculosis （TB）. A total of 500 clinical isolates of M. tuberculosis from the sputum specimens of the patients with TB in 2006-2013 were collected in the four provinces of the southwestern China （Guizhou, Guangxi, Sichuan and Chongqing）. The drug susceptibility of the strains to the four drugs was tested with the drug susceptibility test （DST） of the proportion method. Statistical analyses were carried out by using χ2 analysis and logistic regression analysis. Among all the 500 clinical isolates of M. tuberculosis, the percentages of drug resistance to INH, RFP, EMB and SM were 30. 40%, 26. 00%, 9. 80% and 24.40%, respectively. The total drug resistant rate and multi drug-resistant （MDR） rate were 40.60% and 27.20%, respectively. The total drug res Guizhou, Sichuan, Guangxi a istant rate and nd 46. 15%, 59. 54% and 51. 90 20.19% and 3. 85%, respecti MDR rate in ere 64.10% and and 14. 97%, were significant differences （P〈0.05） in drug-resistant rate to INH, RFP, EMB, SM, the total drug resistance and MDR in these areas. Logistic regression analysis showed that the influence factors were case types and area （P〈0.05）. The drug resistance of tuberculosis was very severe in southwest China, especially in Guizhou and Sichuan. For guiding the clinical medication to prevention and control of drug-resistant TB, we should be more attention to the surveillance of drug resistance of M. tuberculosis.