重庆市耐多药肺结核可疑患者药敏结果分析

Drug susceptibility test to anti-tuberculosis drugs from the suspected MDR-TB patients in Chongqing

目的:通过分析重庆市耐多药肺结核(multidrug-resistant tuberculosis,MDR-TB)可疑患者药敏结果,为重庆市耐多药结核病的发现及控制提供参考和依据。方法:2014年7月至2016年2月重庆市39个区县573例MDR-TB可疑患者痰培养阳性分离株,采用比例法进行4种一线抗结核药物和6种二线抗结核药物的药敏试验,对药敏结果进行统计分析。结果:573例MDR-TB可疑患者的MDR-TB检出率为25.0%,明显高于单耐药结核病(single drug-resistant tuberculosis,SDR-TB)检出率(9.6%)及多耐药结核病(poly drug-resistant tuberculosis,PDR-TB)检出率(8.0%)(P<0.001)。高危人群MDR-TB检出率为26.6%(130/488),明显高于新患者的15.3%(13/85)(P=0.026)。高危人群中,复治失败患者MDR-TB检出率最高,为42.1%(16/38),其次为初治失败患者,为40.0%(18/45)。结论:重庆市耐多药肺结核可疑患者MDR-TB检出率高,耐多药肺结核防控形势严峻。高危人群尤其是复治失败和初治失败患者应该作为耐多药肺结核筛查的重点人群。

Objective：To analyze the drug susceptibility of M.tuberculosis isolates from suspected multidrug-resistant tuberculosis （MDR-TB） patients in Chongqing, so as to provide scientific evidence for MDR-TB discovery and control. Methods：Totally 573 M.tuberculosis isolates from suspected MDR-TB patients were collected from July 2014 to February 2016. Four kinds of first-line anti-TB drugs （INH, RFP, Sm, EMB） and six kinds of second-line drugs （Ofx, Km, Cm, Pto, PAS, Am） were tested for susceptibility by the proportion method. Results：Among the 573 suspected MDR-TB cases, 143 cases（25.0%） were identified as MDR-TB, meanwhile, 55 cases （9.6%） were single drug-resistant tuberculosis （SDR-TB） and 46 cases （8.0%） were poly drug-resistant tuberculosis （PDR-TB）. The proportion of MDR-TB was significantly higher than that of SDR-TB and PDR-TB（P〈0.001 ）. In terms of MDR- TB,the high risk groups had a higher drug resistance rate（26.6%, 130/488） than the new patients（15.3%, 13/85）,P=0.026. Among the high risk groups,the detection rate of MDR-TB was the highest（42.1%, 16/38） in the patients who failed in the re-treatment,followed by those failed in the initial treatment（40.0%, 18/45）. Conclusion：The detection rate of MDR-TB is moderately high among the suspected MDR-TB patients in Chongqing. A long way remained to go in controlling MDR-TB. The screening for MDR-TB should target at high risk groups especially the patients failed in the re-treatment and initial treatment.