115例复治涂阳肺结核患者耐药状况及耐药原因分析

Analysis of drug resistance to anti-tuberculosis drugs of 115 retreatment smear-positive pulmonary tuberculosis

目的探讨115例复治涂阳肺结核患者的耐药状况并分析耐药形成的原因。方法于2014年1月至2017年3月收集陕西省结核病防治研究所及西京医院门诊新登记的所有复治涂阳肺结核患者，共115例，将其痰标本进行分枝杆菌分离培养及菌种鉴定，经培养分离出分枝杆菌97株，其中获得药物敏感性试验（简称“药敏试验”）结果者93株，菌种鉴定为非结核分枝杆菌2株，结核分枝杆菌91株；将此91例肺结核患者作为研究对象，对6种抗结核药物[利福平（RFP）、异烟肼（INH）、链霉素（Sm）、乙胺丁醇（EMB）、左氧氟沙星（Lfx）、卡那霉素（Km）]进行药敏试验，分析耐药情况并进一步调查分析耐药形成的原因。结果91例复治涂阳肺结核患者总耐药率为42．86％（39／91），单耐药率为30．77％（28／91），多耐药率为6．59％（6／91），耐多药率为4．40％（4／91），广泛耐药率为1．10％（1／91）；单耐药率顺位由高到低依次为Lfx（12．09％，11／91），Sm（7．69％，7／91），RFP（5．49％，5／91），INH（2．20％，2／91），EMB（2．20％，2／91），Km（1．10％，1／91）。耐药原因分析发现，医原性因素占57．14％（16／28），患者自身因素占28．57％（8／28），药物因素占14．29％（4／28）。结论115例复治涂阳肺结核患者总耐药率较高，不规范的抗结核药物治疗是耐药形成的主要原因。

Objective To investigate the status of drug resistance of 115 retreatment smear-positive tubercu- losis patients and to analyze the causes of drug resistance. Methods We collected 115 retreatment smear-positive tuberculosis patients from Shaanxi Tuberculosis Prevention and Treatment Institute and newly registered outpatients from Xijing Hospital, and did the Mycobaeterium isolation and strain identification with their sputum specimens. After strain culture, 97 Mycobacterium were isolated, of which 93 has obtained drug susceptibility testing （referred to as ＂susceptibility testing＂） results. Mycoplasma strains were identified as 2 non- and 91 Mycobacterium tuberculosis. We took these 91 tuberculosis patients as research object, and did the susceptibility testing with six kinds of anti-TB drugs （rifampicin （RFP）, isoniazid （INH）, streptomycin （Sin）, ethambutol （EMB）, levofloxacin （Lfx）, Kanamycin （Kin））. We analyzed the status of drug resistance and further investigated the causes of drug resistance formation. Results For the 91 retreatment smear-positive tuberculosis patients, the total drug resistance rate was 42.86% （39/91）, single-drug resistant rate was 30. 77% （28/91）, multi-drug resistant rate was 6.59% （6/91）, the multi- drug-resistant rate （MDR） was 4. 40% （4/91） and the extensively drug resistant rate （XI）R） was 1.10% （1/91）. Single-drug resistant rates from high to low were： Lfx （12.09%, 11/91）, Sm （7.69%, 7/91）, RFP （5.49%, 5/91）, INH （2.20%, 2/91）, EMB （2.20%, 2/91）, Km （1.10%, 1/91）. Drug resistance analysis found, that medical factors accounted for 57.14% （16/28）, patient＇s own factors accounted for 28.57% （8/28）, and the drug factors accounted for 14. 29% （4/28）. Conclusion The total drug resistant rate is relatively high for the 115 retreatment smear-positive tuberculosis patients, and the non-standard anti-TB drug treatment is the main cause for drug resistance.