耐多药/广泛耐药肺结核并发2型糖尿病患者耐药特征分析

Analysis of drug resistance characteristics of MDR/XDR-TB patients complicated with type 2 diabetes mellitus

目的了解并分析耐多药/广泛耐药肺结核并发2型糖尿病患者的耐药特征。方法搜集黑龙江省传染病防治院耐药病区2018年6月至2020年6月收治的经结核分枝杆菌培养及药物敏感性试验(简称"药敏试验")确诊的耐多药/广泛耐药肺结核患者233例,其中并发2型糖尿病者84例(简称"并发糖尿病组"),未并发糖尿病者149例(简称"未并发糖尿病组")。对两组患者的肺结核初复治情况、所耐药品数量、耐药谱进行分析,采用SPSS 18.0软件进行统计学分析,组间计数资料"构成比或率"的比较采用χ^(2)检验,以P<0.05为差异有统计学意义。结果并发糖尿病组初治肺结核26例,占比为30.95%(26/84);未并发糖尿病组初治肺结核16例,占比为10.74%(16/149),两组比较差异有统计学意义(χ^(2)=14.854,P<0.01)。在所耐药品数量上,并发糖尿病组与未并发糖尿病组比较,耐异烟肼与利福平的构成比分别为10.71%(9/84)、7.39%(11/149),耐3种药品的构成比分别为28.57%(24/84)、24.16%(36/149),耐4种药品的构成比分别为19.05%(16/84)、24.83%(37/149),耐5种药品的构成比分别为17.86%(15/84)、19.46%(29/149),耐6种及以上药品的构成比分别为23.81%(20/84)、24.16%(36/149);两组间差异均无统计学意义(χ^(2)值分别为0.759、0.546、1.023、2.063、0.882,P值分别为0.383、0.460、0.312、0.151、0.348)。在耐药谱方面,并发糖尿病组与未并发糖尿病组比较,异烟肼与利福平耐药的比率分别为10.71%(9/84)、7.40%(11/149),氟喹诺酮类药品耐药的比率分别为29.76%(25/84)、29.53%(44/149),抗结核药品二线注射剂耐药的比率分别为4.76%(4/84)、6.71%(10/149),异烟肼与利福平+氟喹诺酮类药品+抗结核药品二线注射剂同时耐药的比率分别为8.33%(7/84)、13.42%(20/149),两组间差异均无统计学意义(χ^(2)值分别为0.760、0.009、0.361、1.358,P值分别为0.383、0.926、0.548、0.244)。结论耐多药/广泛耐药肺结核并发2型糖尿病患者以初治肺结核多见,是否并发糖尿病对耐多药/广泛耐药肺结核所耐药品数量、耐药谱均没有影响。对糖尿病等易感人群要加强防护,避免因感染耐药结核分枝杆菌而发生原发性耐药结核病。

Objective Understand and analyze the drug resistance characteristics of MDR/XDR-TB patients complicated with type 2 diabetes mellitus. Methods Collect 233 MDR/XDR-TB patients diagnosed by Mycobacterium tuberculosis culture and drug sensitivity test(referred to as"drug sensitivity test")from the drugresistant ward of Infectious Hospital of Heilongjiang Province from June 2018 to June 2020,among them,84 cases were complicated with type 2 diabetes mellitus(referred to as "concurrent DM group")and 149 cases were not complicated with DM(referred to as"non-concurrent DM group").The initial retreatment,drug resistance and drug resistance spectrum of the two groups were analyzed,SPSS 18.0 software was used for statistical analysis,the count data was expressed as percentage,the constituent ratio or rate between groups was compared by Chi square test,P<0.05 as the statistically significant difference. Results There were 26 cases of initial treating pulmonary tuberculosis in the concurrent DM group,accounting for 30.95%(26/84),and 16 cases in the non-concurrent DM group,accounting for 10.74%(16/149),the difference between the two groups was statistically significant(χ^(2)=14.854,P<0.01).In terms of the number of drugs resistance,the concurrent DM group was compared with the non-concurrent DM group,the rates of resistance to isoniazid and rifampin were 10.71%(9/84),7.39%(11/149),the rates of resistance to 3 drugs,respectively were 28.57%(24/84)and 24.16%(36/149),the rates of resistance to 4 drugs were 19.05%(16/84)and 24.83%(37/149),the rates of resistance to 5 drugs were 17.86%(15/84)and 19.46%(29/149),and the rates of resistance to 6 or more drugs were 23.81%(20/84)and 24.16%(36/149)respectively,there was no statistical significance difference between the two groups(χ^(2) values were 0.759,0.546,1.023,2.063 and 0.882,and the P values were 0.383,0.460,0.312,0.151 and 0.348).In terms of drug resistance spectrum,the concurrent DM group was compared with the non-concurrent DM group,the resistance rates of isoniazid and rifampin were 10.71%(9/84)and 7.40%(11/149),the rates of fluoroquinolone resistance were 29.76%(25/84)and 29.53%(44/149),the rate of resistance to injection of second-line anti-tuberculosis drugs were 4.76%(4/84)and 6.71%(10/149),the rates of simultaneous resistance to isoniazid and rifampicin,fluoroquinolones,and second-line anti-tuberculosis drugs simultaneously were 8.33%(7/84)and 13.42%(20/149)respectively,there was no statistical significance difference between the two groups(χ^(2) were 0.760,0.009,0.361 and 1.358,and the Pvalues were 0.383,0.926,0.548 and 0.244). Conclusion The majority of MDR/XDR-TB patients complicated with type 2 diabetes mellitus were initial treating pulmonary tuberculosis.Whether complicated with diabetes mellitus had no effect on the number of resistant drugs and the drug resistance spectrum of MDR/XDR-TB patients.It is suggested that we should strengthen the protection of susceptible population such as diabetes,to avoid the occurrence of primary drug-resistant tuberculosis due to infection of drug-resistant Mycobacterium tuberculosis.