2016-2017年四川省10个耐药监测点结核病耐药情况分析

Drug Resistance Analysis of Tuberculosis of 10 Surveillance Areas in Sichuan Province From 2016 to 2017

目的了解四川省耐药结核病的流行状况,为四川省耐药结核病的防控提供科学依据。方法选取苍溪县、大竹县、峨眉山市、涪城区、富顺县、合江县、江油市、绵竹市、通江县及武胜县10个区县为耐药监测点,纳入2016-2017年所有登记的涂阳肺结核患者,采集痰标本,进行痰培养,对培养所得菌株进行抗结核药物敏感性实验。所检测药物及浓度为异烟肼(INH)0.2μg/ml、利福平(RFP)40μg/ml、乙胺丁醇(EMB)2μg/ml、链霉素(SM)4μg/ml、卡那霉素(KA)30μg/ml和氧氟沙星(OF)4μg/ml。构成比的比较采用χ^2检验。结果 909例结核分枝杆菌中总耐药率为23.98%(218/909)、单耐药率为10.78%(98/909)、多耐药率为5.06%(46/909)、耐多药(MDR-TB)率为8.14%(74/909)、总广泛耐药(XDR-TB)率为0.55%(5/909),其中MDR-TB中初治和复治患者分别为42和32例。耐药谱中,任一种耐药谱、单一耐药谱、多耐药谱和耐多药谱的前3位分别为IHN、SM和RFP, INH、SM和OF,耐HS、耐HE和耐HSE,耐HRS、耐HRSOF和耐HR/HRSEOF。结论四川省的结核病耐药疫情仍十分严重,出现了耐药结核病传播加重和氟喹诺酮使用不规范的情况,应调整耐药结核病防控方向,继续做好耐药监测研究,为耐药结核病的防控提供科学的依据。

Objective To understand the prevalence status of tuberculosis(TB) in Sichuan province. In order to provide scientific evidences for drug-resistant TB prevention and control. Methods Ten drug resistance monitoring points were selected,including Cangxi county,Dazhu county,Emeishan city,Fucheng district, Fushun county, Hejiang county, Jiangyou city, Mianzhu city, Tongjiang county and Wusheng county. All patients registered with smear positive pulmonary tuberculosis in 2016-2017 were included. Sputum samples of the patients were collected and detected by solid culture and traditional proportion method drug susceptibility test(DST). The tested drugs and concentration of DST were INH 0.2 μg/ml,RFP 40 μg/ml,EMB 2 μg/ml,SM 4 μg/ml,KA 30 μg/ml and OF 4μg/ml. SPSS19.0 statistical software was used to analyze the data. Chi-square test was used to compare constituent ratio. Results The total drug resistance rate of mycobacterium tuberculosis was23.98%(218/909),the mono drug resistance rate was 10.78%(98/909), multiple drug resistance rate was 5.06%(46/909),the multidrug resistance rate(MDR-TB) was 8.14%(74/909),the total XDR-resistance(XDR-TB) rate was 0.55%(5/909). Among the MDR-TB patients, 42 of them were primary treatment patient and 32 of them were retreatment patient. The first three spectra of any durg resistant,mono resistance,multiple drug resistance,MDR-TB,were IHN,SM and RFP,IHN,SM and OF,HS,HE and HRE,HRS,HRSOF,as well as HR/HRSEOF. Conclusion The epidemic of tuberculosis in Sichuan province is still serious,the spread of drug-resistant tuberculosis and improper use of fluoroquinolone have been increased. The direction of drug-resistant TB prevention and control should be adjusted,the drug resistance monitoring should still be carry on,to provide scientific basis for the prevention and control of drug-resistant tuberculosis.