2016年广东省涂阴培阳肺结核患者耐药情况分析

Analysis of drug resistance in patients with smear-negative and culture-positive pulmonary tuberculosis in Guangdong province in 2016

目的了解广东省涂阴培阳肺结核患者的耐药情况。方法收集广东省2016年1-12月32个结核病耐药监测点12 323例临床确诊的初治涂阴肺结核患者作为研究对象,均进行了分枝杆菌培养检测,其中1224例阳性,涂阴培阳率为9.9%。经菌种鉴定,1177例(96.16%)为结核分枝杆菌复合群,47例(3.84%)为非结核分枝杆菌。对确定为结核分枝杆菌复合群的1177株菌株进行异烟肼(INH)、链霉素(Sm)、利福平(RFP)、乙胺丁醇(EMB)、卡那霉素(Km)、氧氟沙星(Ofx)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸(PAS)等9种药物的药物敏感性试验(简称"药敏试验")。结果 12 323例初治涂阴肺结核患者进行培养,涂阴培阳肺结核患者总耐药率为29.57%(348/1177),耐多药率为2.38%(28/1177),广泛耐药率为0.08%(1/1177),单耐药率为17.42%(205/1177),多耐药率为9.77%(115/1177)。男性耐多药率(2.94%,25/849)高于女性(0.91%,3/328),差异有统计学意义(χ~2=4.20,P=0.040)。多耐药谱有52种类型,其中耐INH+Sm者最多,占20.87%(24/115);其次为耐Sm+Km者(9.57%,11/115)。结论广东省涂阴培阳肺结核患者有较高的耐药率,应加强监测与管理,减少耐药结核病的发生。

Objective This study aimed to investigate the drug resistance status of patients with smearnegative while culture-positive pulmonary tuberculosis(PTB) in Guangdong province.Methods A total of 12 323 newly diagnosed smear-negative PTB patients from 32 tuberculosis drug resistance surveillance sites in Guangdong province during January-December 2016 were collected as research subjects.After sputum culture,1224 were culture positive,with culture positive rate of smear-negative of 9.9%.The results of strain identification tests indicated that 1177 cases(96.16%) were Mycobacterium tuberculosis complex,and 47 cases(3.84%) were nontuberculous mycobacteria(NTM).Then,drug sensitivity tests were performed on 1177 strains identified as Mycobacterium tuberculosis complex with 9 different anti-TB drugs,which were isoniazid(INH),streptomycin(Sm),rifampicin(RFP),ethambutol(EMB),kanamycin(Km),ofloxacin(Ofx),capriomycin(Cm),propionamide(Pto) and p-aminosalicylic acid(PAS).Results Totally,12 323 sputum isolates from newly diagnosed patients with smear-negative PTB were cultured,and the results showed that the total resistance rate was 29.57%(348/1177),including a multidrug resistance(MDR) rate of 2.38%(28/1177),extensive drug resistance(XDR)rate of 0.08%(1/1177),single drug resistance rate of 17.42%(205/1177),and a polyresistance rate of 9.77%(115/1177).We also found that the MDR rate(2.94%,25/849) in men were significantly higher than those in women(0.91%,3/328),with significant statistical differences(χ~2=4.19,P=0.040).There were 52 types of MDR spectrum,among which,INH+Sm resistant types were the most,accounting for 20.87%(24/1150,followed by Sm+Km resistant types,accounting for 9.57%(11/115).Conclusion Patients with smear-negative and culture-positive PTB in Guangdong province have a higher drug resistance rate.Monitoring and management should be strengthened to reduce the occurrence of drug-resistant tuberculosis.