134例耐多药肺结核耐药情况分析

Analysis of drug susceptibility in 134 cases of multidrug-resistant tuberculosis

目的了解2013年-2016年衢州地区耐多药肺结核的耐药情况,为衢州地区耐多药肺结核的治疗与控制提供科学依据。方法对2013年-2016年衢州市各结核定点医院上送的结核菌株采用BACTEC MGIT 320系统进行一线抗结核药物异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)和二线药物卡那霉素(KM)、氧氟沙星(OFX)的耐药性检测。结果 2 328株结核分枝杆菌中分离出耐多药结核菌株134株,耐多药率为5.76%;耐多药结核菌株对SM的耐药率为75.37%,EMB耐药率为18.66%,OFX耐药率为53.73%,KM为11.94%;134株耐多药菌株中,耐药组合以INH+RFP+SM+OFX最为常见,其次是INH+RFP+SM和INH+RFP,初治肺结核的耐药组合排前3位的是INH+RFP+SM+OFX、INH+RFP、INH+RFP+SM,复治肺结核的耐药组合排前3位的是INH+RFP+SM+OFX、INH+RFP+SM、INH+RFP。结论衢州市MDR-TB对一线、二线药物的耐药性相当严重,开展耐多药结核病的免费筛查工作,早期发现耐多药结核病患者,开展耐多药结核病的免费治疗,降低耐多药结核病的产生和流行。

Objective To analyze the status of multi-drug resistance tuberculosis in Quzhou during 2013-2016,so as to provide scientific basis for the treatment and control of multidrug-resistance tuberculosis. Methods Mycobacterium tuberculosis strains isolated from the designated hospitals in Quzhou during 2013-2016 were conducted for the drug resistance test to first-line antituberculosis drugs,isoniazid（INH）,rifampicin（RFP）,streptomycin（SM）,ethambutol（EMB） and second-line drugs kanamycin（KM）,ofloxacin（OFX） by BACTEC MGIT 320. Results A total of 134 multidrug-resistant ones were isolated from 2 328 strains of Mycobacteria tuberculosis,with the muitidrug-resistant rate of 5. 76%; the resistance rate of multi drug resistant strains to SM was 75. 37%,the rate to EMB was 18. 66%,the rate to OFX was 53. 73%,and the rate to KM was11. 94%. Among the 134 cases of multidrug-resistant Mycobacteria tuberculosis,the resistance to INH ＋ RFP ＋ SM ＋ OFX was the most common,followed by INH ＋ RFP ＋ SM and INH ＋ RFP; the first three antibiotic resistance combinations of the initial treatment of tuberculosis were INH ＋ RFP ＋ SM ＋ OFX,INH ＋ RFP,and INH ＋ RFP ＋ SM. The top three antibiotic resistance combinations for retreatment of tuberculosis were INH ＋ RFP ＋ SM ＋ OFX,INH ＋ RFP ＋ SM,INH ＋ RFP. Conclusion There are relatively high resistant rates to first and second line drugs among multidrug-resistant tuberculosis in Quzhou,we should carry out free test in order to find multidrug resistant tuberculosis and provide free treatment,reduce the emergence and prevalence of multidrug-resistant tuberculosis.