台州市2015—2017年涂阳肺结核病例耐药性分析

Drug resistance analysis on smear-positive pulmonary tuberculosis in Taizhou City from 2015 to 2017

【目的】了解浙江省台州市肺结核病例的耐药情况,为制定肺结核防控策略提供依据。【方法】对2015—2017年在台州市耐药监测点连续纳入的267例涂阳病例的痰标本,进行结核分枝杆菌培养、菌群鉴定。采用比例法药敏试验进行9种抗结核药物[异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、卡那霉素(KAM)、氧氟沙星(OFX)、卷曲霉素(CPM)、丙硫异烟胺(PTO)和对氨基水杨酸钠(PAS)]的药物敏感性试验。【结果】267例病例中,送检培养220例,培养阳性190例(17例鉴定为非结核分枝杆菌感染),培养阴性28例,污染2例。160例有9种抗结核药物的药敏试验结果,总耐药率为22. 5%,初治组耐药率为21. 4%,复治组耐药率为33. 3%,两组差异无统计学意义(P>0. 05)。耐多药率为3. 1%,初治组耐多药率为0. 7%,复治组耐多药率为26. 7%,两组差异有统计学意义(P <0. 01)。9种药物的耐药顺位依次为INH(8. 1%)、PTO(8. 1%)、SM(6. 9%)、RFP(6. 3%)、OFX(2. 5%)、PAS(2. 5%)、EMB(2. 5%)、CPM(2. 5%)和KAM(2. 5%)。不同性别耐药率差异无统计学意义(P>0. 05)。不同年龄组耐药率差异无统计学意义(P>0. 05)。【结论】对台州市耐药结核病疫情仍需引起重视,特别是获得性耐多药疫情。须继续完善"三位一体"管理模式,提高临床诊疗质量,强化社区服药管理。

[Objective] To ascertain the drug resistance for pulmonary tuberculosis in Taizhou City,and to provide basis for tuberculosis prevention and control strategy.[Methods] The sputum samples were collected form 267 smear positive pulmonary tuberculosis patients who registered in a drug susceptibility testing(DST)monitoring site in Taizhou City form 2015 to 2017.Then with culture,identification of Mycobacterium and DST for 9 anti-tuberculosis drugs [isoniazid(INH),rifampicin(RFP),ethambutanol(EMB),streptomycin(SM),kanamycin(KAM),ofloxacin(OFX),crinkledmycin(CPM),promethylamine(PTO)and para amino salicylate(PAS)] by using proportion method performed on all sputum specimens.[Results] Of the 267 smear positive cases,220 were cultured with 190 culture positive(17 were identified as nontuberculous mycobacterial infections),28 culture negative,and 2 contaminated.Among 160 cases with the result of DST to 9 drugs,the overall drug resistance rate was 22.5%.The overall drug resistance rates were 21.4% and 33.3% in the newly diagnosed patients and retreated patients respectively.There was no significant difference between the two groups(P >0.05).The multidrug resistance rate was 3.1%,and had a significant difference between the new and retreated patients(0.7% vs.26.7%,P<0.01).Drug resistances rates of the 9 drugs ranged from high to low as:INH(8.1%),PTO(8.1%),SM(6.9%),RFP(6.3%),OFX(2.5%),PAS(2.5%),EMB(2.5%),CPM(2.5%)and KAM(2.5%).There was no gender difference found in drug resistance rates(P >0.05).Neither was there age difference(P >0.05).[Conclusion] The epidemic of drug-resistant of tuberculosis in Taizhou City are still high,especially that of acquired multi-drug resistance of tuberculosis.We must continue to improve the“three-in-one”management model,improve the quality of clinical diagnosis and treatment,and strengthen community medication management.