264例痰培养阳性肺结核患者对氧氟沙星和卡那霉素耐药情况分析

Analysis of resistance to ofloxacin and kanamycin of 264 sputum culture positive tuberculosis

目的了解痰培养阳性肺结核患者对氧氟沙星、卡那霉素的耐药情况,为结核病的预防控制和临床治疗提供参考。方法对2012-2016年盐都区264株痰培养阳性结核菌株,采用比例法进行利福平(RFP)、异烟肼(INH)、氧氟沙星(Ofx)及卡那霉素(Km)药物敏感性试验,并分析耐药情况。采用SPSS 18.0软件进行数据分析,计数比较采用卡方检验,P<0.05为差异有统计学意义。结果本研究最后纳入的264例患者中,初治199例,复治65例,结核分枝杆菌对Ofx的耐药率(9.47%,25/264)高于对Km的耐药率(3.03%,8/264)(χ~2=9.341,P=0.002)。在仅耐1种药病例中,耐Km率(7.41%)低于耐Ofx率(37.04%)(χ~2=6.857,P=0.008)。耐多药病例中,耐Ofx率(45.45%)高于耐Km率(13.60%)(χ~2=5.349,P=0.020)。耐药病例中,耐Km率(14.81%)低于耐Ofx率(46.30%)(χ~2=12.610,P<0.001)。男性患者对Ofx的耐药率(11.94%,24/201)高于女性患者(1.59%,1/63)(χ~2=5.997,P=0.014)。结论盐都区痰培养阳性肺结核病例对二线抗结核药的耐药率较高,尤其是对Ofx的耐药,给我区结核病尤其是耐药结核病的控制工作带来了严峻的挑战,临床上应该根据药敏试验结果制定合理有效的治疗方案。

Objective To investigate the resistance of ofloxacin（ Ofx） and kanamycin（ Km） of sputum culture positive tuberculosis and to provide a reference for TB＇s prevention and treatment. Methods 264 sputum culture positive cases from 2012 to 2016 were tested by proportion method of drug sensitivity（ RFP,INH,OFx and Km） with chi-square test（ χ^2-test）. Results There were 199 initial-treated patients and 65 re-treated patients.The resistance of Ofx was higher than Km（ χ^2= 6. 857,P = 0. 008）,such as in one or many medicine tolerance cases. The resistance of men was higher than women（ χ^2= 5. 997,P = 0. 014）. Conclusion The resistance of TB patients is high,especially with Ofx,so some active treatment prescription should be made in clinic on the basis of drug sensitive test.