2O13—2016年遵义地区870例肺结核患者耐药状况分析

Analysis of the drug-resistant status of 870 patients with pulmonary tuberculosis from 2013 to 2016

目的分析近年来就诊于贵州省遵义医学院附属医院肺结核患者的耐药情况，为耐药结核病的防控提供依据。方法选取20132016年期问就诊于遵义医学院附属医院的肺结核患者870例，采集患者的痰液及肺泡灌洗液标本，采用罗氏培养及比例法进行4种一线抗结核药物（异烟肼、利福平、乙胺丁醇、链霉素）的药物敏感性试验（简称“药敏试验”），并将患者的耐药情况进行比较分析。结果870例肺结核患者中，初治患者611例。复治患者259例；患者总耐药率为26．6％（231／870），耐多药率为12．1％（105／870）。初治患者的总耐药率为16．4％（100／611），复治患者的总耐药率为50．6％（131／259），差异有统计学意义（x2=56．74，P〈0．01）。初治患者的单耐药率为9．7％（69／611），复治患者的单耐药率为10．0％（26／259），差异无统计学意义（x2=0．03，P=0．862）。初治患者的多耐药率为3．1％（19／611），复治患者的多耐药率为8．5％（22／259），差异有统计学意义（x2=11．74，P〈0．01）。初治患者的耐多药率为3．6％（22／611），复治患者的耐多药率为32．0％（83／259），差异有统计学意义（x2=138．69，P〈0．01）。结论复治增加耐药风险，应加强复治肺结核患者耐药筛查，强调规范化治疗。

Objective To understand the situation of drug resistant tuberculosis in the Affiliated Hospital of Zunyi Medical College in order to provide scientific evidence for the drug resistant tuberculosis prevention and control strategies. Methods A total of 870 Mycobacterium tuberculosis isolates composed of sputum and bronchoal- veolar lavage fluid were collected from patients with pulmonary tuberculosis （PTB） in the Affiliated Hospital of Zunyi Medical College during the years of 2013 to 2016. Drug sensitivity tests against 4 anti-TB drugs （rifampicin, isoniazid, ethambutol and streptomycin） were performed using the Roche culture and proportion method. The demographic and drug resistance information were collected. Results Among the 870 cases, 611 cases were new pa tients and 259 cases were previously treated patients. The total rates of drug resistant and muhidrug-resistanl （MDR） were 26.6% （231/870） and 12.1% （105/870）,respectively. The total drug resistant rates of new and previously treated patients were 16.4% （100/611） and 50.6% （131/259）,respectively, and the difference was statistically significant （x2= 56.74, P〈0.01）. The single drug resistance rates of new and previously treated patients were 9.7% （59/611） and 10.0% （26/259）, respectively, and the difference was not statistically significant （x2=0.03, P= 0. 862）. The polyresistance rates of new and previously treated patients were 3. 1% （19/611） and 8.5% （22/259）, respectively. The difference was statistically significant （x2 = 11.74, P〈0.01）. The MDR rates of new and previously treated patients were 3.6% （22/611） and 32.0% （83/259）, respectively. And the difference was statistically significant （X2=138.69, P〈0.01）. Conclusion Retreatment would increase the risk of TB＇s resis tance to drugs. Consequently, there is a urgent call for the improvement of drug resistance screening and standar- dized treatment for retreated PTB patients.