雅安市280株结核分枝杆菌对抗结核药物的耐药情况分析

Drug Resistance of 280 Mycobacterium Tuberculosis Strains in Ya’an City

目的了解雅安市结核分枝杆菌对6种抗结核药物的耐药情况,为雅安市结核病防控工作提供参考数据。方法收集2014-09/2019-02雅安市结核病可疑患者痰培养分离株280株,采用比例法药敏试验对分离株进行6种抗结核药物敏感性试验,检测药物包括异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、氧氟沙星(OFX)、卡那霉素(KM)。率的比较采用SPSS 23.0软件进行χ~2检验。结果280株结核分枝杆菌中总耐药率为22.86%,单耐药率为13.21%,多耐药率为3.21%,耐多药率为6.23%。复治涂阳患者总耐药率和耐多药率均高于初治涂阳患者和涂阴培阳患者。任一耐药率排前3位的为INH、SM、OFX,单耐药排前3位的为OFX、INH、SM,多耐药排名第1位的为INH+SM,耐多药排名第1位的为INH+RFP。结论雅安市结核分枝杆菌耐药情况不容乐观,要加强对病人的治疗管理,规范用药,应积极推广分子生物学检测技术,将各种检测技术联合应用,尽早发现耐药患者,减少耐药结核病传播。

Objective To understand the resistance of Mycobacterium tuberculosis to six anti-tuberculosis drugs in Ya’an City so as to provide references for the prevention and control of tuberculosis.Methods A total of 280 isolates from sputum of suspected TB patients from September 2014 to February 2019 in Ya’an city.Then,six anti-tuberculosis drug sensitivity tests were performed on the isolates using the proportional sensitivity test.The detection drugs included isoniazid(INH),rifampicin(RFP),ethambutol(EMB),streptomycin(SM),ofloxacin(OFX),and kanamycin(KM).Chi-square test was used for rate comparison.Results The total drug resistance rate of 280 strains of Mycobacterium tuberculosis was 22.86%.The single-drug resistance rate was 13.21%,the multi-drug resistance rate was 3.21%,and the multidrug-resistance rate was 6.23%.The total drug resistance rate and multidrug-resistance rate in retreated smear positive patients were higher than those in newly treated smear positive patients and smear-negative and culture-positive patients.INH,SM,OFX ranks in the top 3 of the overall drug resistance rate,OFX,INH,SM ranks in the top3 of the single-drug resistance rate,and INH+SM ranks in the first of the multidrug-resistance rate,and INH+RFP ranks in the first of the multi-drug resistance rate.Conclusion The drug resistance situation of Mycobacterium tuberculosis in Ya’an City is not optimistic.To strengthen the treatment management of patients and standardize drug use,we should actively promote molecular biological detection technology.A combination of various detection techniques is needed aiming to detect drug-resistant patients early and reduce the spread of drug-resistant TB.