重庆市肺结核患者异烟肼与丙硫异烟胺耐药状况分析

Resistance to isoniazid and protionamide in pulmonary tuberculosis patients in Chongqing, China

目的了解重庆市结核分枝杆菌异烟肼(INH)、丙硫异烟胺(Pto)及其交叉耐药情况,为重庆市耐药结核病的防控提供参考。方法根据重庆市2015-2017年39个区县培养阳性菌株的传统药敏试验结果,收集288例INH或Pto任意耐药菌株,分析其耐药情况。结果 288例菌株中,INH耐药菌株285例,Pto耐药菌株19例,交叉耐药菌株16例。复治患者INH或Pto的耐药率均高于初治患者,年龄15～44岁患者Pto耐药率显著高于INH组。Pto耐药组Pre-XDR-TB及Ofx耐药率显著高于INH组。交叉耐药菌株中,年龄15～44岁组交叉耐药率较高,且MDR-TB发生率高达93.8%。结论重庆市INH与Pto耐药情况已较为严重,医生在为INH耐药患者制定化疗方案时应根据药敏结果,应谨慎选择Pto进行替代治疗,以避免更多耐药的发生。

In this study,we investigated the drug-resistant characteristics of isoniazid(INH)-resistant strains,protionamide(Pto)-resistant strains and their cross-resistant strains in tuberculosis patients,to provide evidences for the prevention and control of drug-resistant patients in Chongqing.According to the result of drug susceptibility test,288 strains that any-drug resistant to INH and Pto were collected and analyzed for their drug-resistant characteristics.Among the 288 any-drug resistant strains,285 strains were INH-resistance,19 strains were Pto resistance and 16 strains were cross-resistance to INH and Pto.Drug resistant rate of INH or Pto in retreatment patients was higher than in initial patients;patients from 15 to 44 years old group have much higher Pto resistant rate than INH resistant rate(P﹤0.05).Pre-XDR rate and ofloxacin resistant rate in Pto resistant group were much higher than in INH resistant group(P﹤0.05).In INH and Pto cross-resistant strains,the cross-resistant rate was higher in the patients from 15 to 44 years old group compared to other groups,there was no INH and Pto cross-resistant patients in more than 60 years old group;the MDR rate in cross-resistant strains was up to 93.8%and the XDR-TB rate was up to 43.8%.For the regional distribution,56.2%INH and Pto cross-resistant patients was in Wanzhou District.For the 16 INH and Pto cross-resistant strains,there were nine kinds of drug resistant types and one patient was drug-resistance to all the ten kinds of drugs.Drug resistance for INH or Pto is serious in Chongqing.The regimen for INH-resistant patients should be according to the drug susceptibility result and choose Pto as a replacement carefully,to avoid further drug resistance.