2018年四川省4865例涂阳结核患者耐药分析

Drug Resistance in 4967 Cases of Patients With Smear-positive Tuberculosis in Sichuan Province

目的了解2018年四川省结核分枝杆菌耐药状况,为评价、完善四川省结核病防治规划提供基础科学依据。方法对四川省各地区2018-01/12期间纳入监测的涂阳痰标本进行分离培养,并采用比例法对分离培养得到的分枝杆菌进行鉴定,对结核分枝杆菌进行RFP、INH、EMB、SM、KM和OFX的药物敏感性试验。耐药率的比较采用χ2检验,以P<0.05为差异有统计学意义。结果4967例纳入分析的患者中,非结核分枝杆菌NTM占总体患者的2.05%(102/4967)。最终纳入耐药分析的例数为4865例,其中初治患者4244例,复治患者621例。总耐药率为18.62%(906/4865),初治15.95%(677/4244),复治36.88%(229/621);单耐药率为9.09%(442/4865),多耐药率为3.10%(151/4865),耐多药率为6.43%(313/4865),广泛耐药率为0.47%(23/4865)。耐药谱有44种类型,其中单耐药6种,多耐药23种,耐多药15种(含广泛耐药3种)。6种检测药物耐药率顺位从高到低依次为INH>RFP>SM>OFX>EMB>KM。结论四川省结核病尤其是耐药结核病的防控有了一定的成效,但仍然面临较大的挑战,面对复治患者的耐药挑战,耐药谱呈现多态性和复杂性,应采取强有力的干预措施,遏制耐药结核病的流行。

Objective To understand the status of mycobacterium tuberculosis resistance in Sichuan Province so as to provide scientific basis for evaluating and improving the tuberculosis control program in Sichuan Province.Methods Samples of smear-positive from January to December 2018 in Sichuan Province were isolated and cultured.The proportion method was used to identified the mycobacterium isolates.Further,drug sensitivity tests(RFP,INH,EMB,SM,KM and OFX)were conducted for mycobacterium tuberculosis.SPSS 19.0 was used to analyze the data.Results NTM accounted for 2.05%of the total of the 4967 patients included in the analysis.The number of cases finally included in the analysis of drug resistance was 4865,including 4244 patients with initial treatment and 621 patients with retreatment.The rates of total drug resistance,initial treatment and retreatment were 18.62%,15.95%and 36.88%,respectively.The rates of mono-drug resistance,poly-drug resistance,multi-drug resistance and extensive drug resistance were 9.09%,3.10%,6.43%,and 0.47%,respectively.There are 44 types of drug resistance spectrum,including 6 mono-drug resistance,23 poly-drug resistance and 15 multidrug resistance(including 3 extensive resistant drugs).The single drug resistance rates ranking from high to low were INH,OFX,SM,RFP,KM and EMB.Conclusion The prevention and control of tuberculosis has made some achievements in Sichuan Province,especially drugresistant tuberculosis,but still faces great challenges.In facing of the drug-resistant challenge of retreatment patients,strong intervention measures should be taken to curb the prevalence of drugresistant tuberculosis.