河北省邯郸市结核病分枝杆菌耐药性监测研究

Surveillance study of drug resistance of mycobacterium tuberculosis in Hebei Handan

目的了解邯郸市肺结核耐药状况,为今后肺结核规范治疗管理、预防与控制结核病的发生或流行(特别是耐药菌株的流行)和减少传染源提供参考依据。方法将2014年1月~2015年12月年邯郸市辖区16个县(市、区)结核病定点医疗机构、市传染病医院上送的所有初治及复治痰结核分枝杆菌培养阳性病例作为研究对象,采用比例法对4种抗结核药物异烟肼(H)、利福平(R)、左氧氟沙星(Lfx)、卡那霉素(Km)进行治疗前药物敏感试验。结果 (1)4种抗结核药物的总体耐药率顺序由高到低依次为:H(23.17%)、R(19.01%)、Lfx(6.34%)、Km(4.16%);初治组耐药率顺序由高到低依次为:H(16.43%)、R(11.59%)、Km(3.62%)、Lfx(2.66%);复治组耐药率顺序由高到低依次为:H(53.85%)、R(52.75%)、Lfx(23.08%)、Km(6.59%)。(2)505例涂阳肺结核病人总耐药率27.93%,耐多药率13.07%,其中初治组耐药率19.08%、耐多药率6.76%,复治组耐药率68.13%、耐多药率41.76%。(3)复治组耐药率及耐多药率均高于初治组,差异有统计学意义(χ~2=60.64、χ~2=56.89,P<0.05)。结论邯郸市肺结核耐药率处于全国较高水平,防治任务非常严峻,应进一步加强肺结核病人的治疗、督导和管理,提高检测水平和及时病人发现,加大对耐药结核病控制工作的投入。

Objective To find out the current situation of drug reference to reduce the source of infection and standardized sis. Methods In 2014. 1 - 2015.12 our city 16 counties（city, - resistance pulmonary tuberculosis in Han Dan City, it provide management in the future treatment of pulmonary tuberculo- district） TB designated medical institutions, infectious diseases hospital, all the initial treatment and re - treatment smear positive sputum cuhure were enrolled as study population, drug sus- ceptibility of mycobacterium tuberculosis to isoniazid （ H）, lifuping （ R）, left ofloxacin （ Lfx）, kanamycin （Km） was tested by proportion method before treatment. Results （1）The overall resistance of four kinds of anti tuberculosis drugs rate order from high to low was： H（23. 17% ）, R（ 19.01% ）, Lfx（6. 34% ）, Kin（4. 16% ） ; the order of initial treatment group resistance rate from high to low is： H（ 16.43% ）, R（ll. 59% ）, Kin（3.62% ）, Lfx（2. 66% ） ; the order of re - treatment group resistance rate from high to low was： H（53.85% ）, R（52. 75% ）, Lfx（23.08% ）, Kin（6. 59% ）. （2）505 cases total resistance rate of sputum culture positive pulmonary tuberculosis patients was 27.93%, muhidrug resistant rate was 13.07%, the initial treatment group 19. 08%, the resistance rate of muhidrug resistant rate was 6. 76%, the re - treatment group 68. 13%, the resistance rate of muhidrug resistant rate was 41.76%. （3）The re - treatment group resistance rate and muhidrug resistant rate were signifi- cantly higher than the initial treatment group, the difference was statistically significant （X2 = 60. 64, X2 = 56. 89, P 〈 0. 05 ）. Conclusion Tuberculosis drug resistance rate is higher in Handan compared with the nationwide, mission control is very serious, further strengthening the treatment and supervision and management of pulmonary tuberculosis patients, improving the detection level and found the patients, increasing the drug resistant tuberculosis control work.