海南省2014-2016年128株耐多药结核分枝杆菌药敏结果

Drug sensitivity tests of multidrug-resistant Mycobacterium tuberculosis in Hainan,2014-2016

目的分析耐多药结核分枝杆菌药物敏感性试验结果,为制定本地区的耐多药结核病治疗方案提供科学依据。方法收集2014年1月—2016年12月期间海南省结核病医院收治的经痰分离培养药物敏感性试验鉴定为耐多药的菌株共128株,对其结果进行分析。结果 6种抗结核药物耐药率由高到低依次为链霉素(Sm)54.69%,氧氟沙星(Ofx)51.56%,乙胺丁醇(EMB)27.34%,卡那霉素(Km)10.94%,卷曲霉素(CPM)5.47%,丙硫异烟胺(Pto)1.56%;3年间,EMB耐药率差异有统计学意义(P<0.05),2016年EMB耐药率(42.50%)明显高于2014(20.41%)和2015(20.51%)年;3年间Sm、Ofx、Km、CPM、Pto耐药率变化差异均无统计学意义(P>0.05);耐多药组合模式有18种之多,前3顺位组合模式耐药率依次为(INH+RFP)20.31%,(INH+RFP+Sm)18.75%,(INH+RFP+Ofx)14.84%;前3顺位耐多药种类耐药率依次为耐3种药35.94%,耐4种药25.00%,耐2种药20.31%。结论海南省耐多药结核病耐药谱广泛且复杂。Km、CPM、Pto耐药率较低,耐多药标准化治疗方案可选价值大。

Objective To summarize the results of drug sensitivity test （DST） of multidrug-resistant Mycobacterium tuberculosis （Mtb）, so as to provide an evidence for formulating the suitable therapeutic schedule of multidrug-resistant tuberculosis （MDR-TB） in the region. Methods From January 2014 to December 2016, a total of 128 multidrug-resistant Mtb strains identified by DST were collected in Tuberculosis Hospital of Hainan Province, and the DST results were analyzed. Results The drug resistance rates of 6 kinds of anti-tuberculosis drugs from high to low in turn were streptomycin （Sm） （54.69%）, ofloxacin （Ofx） （51.56%）, ethambutol （EMB） （27.34%）, kanamycin （Km） （10.94%）, capreomycin （CPM） （5.47%）, and protionamide （Pto） （1.56%）. There was a significant difference in the drug resistance of EMB in the past 3 years （P〈0.05）. In 2016, the resistance rate of EMB （42.50%） was significantly higher than that （20.41%） in 2014 and that （20.51%） in 2015 （P〈0.05）. There was no significant difference in the rates of drug resistance of Sm, Ofx, Km, CPM and Pto in the past 3 years （all P〉0.05）. There were 18 kinds of multidrug-resistant combinations, the resistance rates of the top 3 combinations in turn were： INH＋RFP （20.31%）, INH＋RFP＋Sm （18.75%）, and INH＋RFP＋Ofx （14.84%）. The resistance rates of the top 3 multidrug-resistant types in turn were： resistant to 3 kinds of drugs （35.94%）, resistant to 4 kinds of drugs （25.00%）, and resistant to 2 kinds of drugs （20.31%）. Conclusion The drug resistance spectrum of MDR-TB in Hainan Province is extensive and complex, and the drug resistance rates of Km, CPM and Pto are relatively low, so we should focus on these drugs for the standardized therapeutic schedule of MDR-TB.