重庆市结核病患者利福平耐药与耐多药的相关性分析

Correlation of rifampicin resistance and multidrug-resistance in tuberculosis patients in Chongqing

目的了解重庆市结核病患者利福平(rifampicin, RFP)耐药与耐多药的相关程度,为重庆市RFP耐药及耐多药结核病患者的准确诊断和及时治疗提供科学依据。方法收集重庆市公共卫生医疗救治中心2017-2019年收治的培养阳性且鉴定为结核分枝杆菌的患者菌株,进行以下十种抗结核药物的药敏试验:RFP、异烟肼(isoniazid, INH)、链霉素、乙胺丁醇、氧氟沙星、卡那霉素、阿米卡星、卷曲霉素、对氨基水杨酸和丙硫异烟胺。共收集菌株937例,分析其RFP和INH耐药情况。结果 937例菌株中,RFP耐药菌株288例,RFP耐药INH敏感菌株比例为20.14%(58/288);RFP敏感菌株为649例,其中INH耐药菌株占比7.09%(46/649)。重庆市耐多药患者比例为24.55%,广泛耐药肺结核患者占比2.99%。无论RFP耐药还是RFP敏感菌株中,INH耐药或敏感的患者在年龄、性别和治疗史方面差异均无统计学意义。结论重庆市RFP耐药结核病患者中有较高比例为异烟肼敏感患者,RFP耐药不适合作为重庆地区耐多药患者确诊的指标,应采取有效手段同时检测RFP和INH耐药情况,以指导临床医生为结核病患者制定合理的化疗方案,推动重庆市结核病防治工作的进展。

Objective To investigate and analyze the correlation of rifampicin(RFP) resistance and multidrugresistance in tuberculosis patients, and provide scientific advice for early diagnosis and treatment of RFP-resistant and multidrug resistant tuberculosis patients in Chongqing. Methods The culture positive tuberculosis strains were collected from Chongqing Public Health Medical Center from 2017 to 2019, and drug susceptibility testing(DST, proportion method) for ten kinds of anti-tuberculosis drugs were identified, including RFP, isoniazid(INH), streptomycin(Sm), ethambutol(EMB),ofloxacin(Ofx), kanamycin(Km), amikacin(Am), capreomycin(Cm), p-aminosalicylic acid(PAS) and protionamid(Pto).Finally, 937 tuberculosis strains were collected, and their drug-resistant state of RFP, INH and their correlation was analyzed.Results In 937 tuberculosis strains, RFP resistant strains were 288 cases, RFP resistant but INH sensitive strains were 58 cases, reach to 20.14%(58/288);RFP-sensitive strains were 649 cases, and INH resistant strains were 7.09%(46/649). The proportion of multidrug-resistant(MDR-TB) patients in Chongqing was 24.55%, and the proportion of extensively drugresistance tuberculosis(XDR-TB) patients was 2.99%. In RFP resistant or RFP sensitive strains, INH resistant or sensitive strains had no significant difference in different age groups, genders and history of treatment. Conclusion There are still a certain proportion of INH sensitive strains in RFP resistant strains, RFP resistance was not suitable as an indicator of multidrug resistance in tuberculosis patients in Chongqing. It is necessary to test both RFP and INH resistant state, in order to make reasonable regimens for tuberculosis patients and promote the progress of tuberculosis control in Chongqing.