糖尿病合并初治肺结核患者结核分枝杆菌耐药性分析

Analysis of drug resistanceto mycobacterium tuberculosis in diabetic patients with initially-treated pulmonary tuberculosis

目的分析糖尿病合并初治肺结核患者对一线、二线抗痨药耐药情况,以及不同糖化血红蛋白(Hb A1c)水平时的耐药率。方法收集2017年1~12月安徽省胸科医院住院患者中痰培养阳性初治肺结核患者296例,按是否患糖尿病分为单纯初治肺结核(对照组)170例和糖尿病合并初治肺结核(观察组)126例。比较两组患者对4种一线药物异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)和5种二线药物丁胺卡那(Am)、卷曲霉素(Cm)、左氧氟沙星(Lvfx)、对氨基水杨酸钠(Pas-Na)、丙硫异烟胺(Pto)的耐药率。同时,观察组患者按照Hb A1c值不同分为3组:Hb A1c<7%组、7%≤Hb A1c<9%组、Hb A1c≥9%组,比较观察组不同Hb A1c水平时对上述4种一线药物和5种二线药物的耐药率。结果观察组患者总耐药率、单耐药率、任一耐异烟肼率高于对照组,差异有统计学意义(P<0.05);观察组患者耐多药率、多耐药率和任一耐R、S、E、Am、Cm、Lvfx、Pas-Na、Pto率均高于对照组,但差异无统计学意义(P>0.05);观察组中,不同Hb A1c水平下的耐药率分别为13.79%、34.15%、85.19%,差异有统计学意义(P<0.05)。结论糖尿病合并初治肺结核患者耐药率高;Hb A1c水平越高,耐药率越高。

Objective To analyze the drug resistance to first-line and second-line anti-tuberculosis drugs in those diabetic patients with initially-treated pulmonary tuberculosis and their resistance rates at different blood levels of glycosylated hemoglobin（ Hb A1 c）.Methods 296 patients with initially-treated pulmonary tuberculosis and positive sputum culture results,admitted in our hospital between Jan 2017 and Dec 2017,were collected and divided into two groups according to their diabetes history. 126 cases with diabetes and initially-treated pulmonary tuberculosis were set as the study group,and other 170 cases only with initially-treated pulmonary tuberculosis were included in the control group. Their resistance rates to four kinds of first-line drugs（ isoniazid,rifampicin,ethambutol and streptomycin） and five kinds of second-line drugs（ amikacin,capreomycin,levofloxacin,sodium aminosalicylate and protionamide） between the two groups were compared. Meanwhile,patients in the study group were further divided into three subgroups according to their blood Hb A1 clevels： subgroup with Hb A1c〈 7%,subgroup with 7% ≤Hb A1c 〈9% and subgroup with Hb A1 c≥9%. Their resistance rates to the above mentioned four first-line drugs and five second-line drugs among different Hb A1 clevels were compared within the study group. Results The rates of total and single drug resistance,The resistance rate to isoniazid in the study group was much higher than that in the control group,and difference between them was statistically significant（ P〈0. 05）. Although multidrug resistance and polyresistance,together with the resistance rate to any of rifampicin,streptomycin,ethambutol,amikacin,capreomycin,levofloxacin,sodium aminosalicylate and protionamide,in the study group were all higher than those in the control group,but no significant difference was found between the two groups（ P〉0. 05）. In the study group,their resistance rates at different blood Hb A1 clevels were 13. 79%,34. 15% and 85. 19%,respectively,and differences among them were statistically significant（ all P〈0. 05）. Conclusion The drug resistance rate to anti-tuberculosis drugs would increase in those diabetic patients with initially-treated pulmonary tuberculosis,and the higher their Hb A1 clevels are,the higher their drug resistance rates would be.