河北省秦皇岛市2015—2019年肺结核患者耐药情况分析

Analysis of drug resistance of pulmonary tuberculosis cases in Qinhuangdao,Hebei,2015-2019

目的了解秦皇岛市2015—2019年肺结核患者耐药情况,为耐药肺结核的治疗和预防提供科学依据。方法选取2015年1月—2019年12月病原学阳性新患者和复发患者共1 095例进行传统药敏检测,鉴定为结核分枝杆菌1 065例。通过结核分枝杆菌比例法药敏试验对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、氧氟沙星(OFX)、卡那霉素(KM)进行敏感性检测。结果 1 065例患者中,耐药133例,总耐药率12.49%。新患者910例,耐药73例,耐药率8.02%;复发患者155例,耐药60例,耐药率38.71%。两者耐药率差异有统计学意义(P<0.05)。男性患者耐药率12.64%,女性患者耐药率12.03%,两者耐药率差异无统计学意义(P>0.05)。年龄组之间耐药率差异有统计学意义(P<0.05),20~<40岁年龄组耐药率最高,为17.30%。RFP、INH、SM、EMB、OFX在两类患者中耐药差异均有统计学意义(P<0.05)。本次研究共发现16种耐药谱,单耐药五种共52例,单耐药率为4.88%;多耐药三种共5例,多耐药率为0.47%;耐多药八种共76例,耐多药率为7.14%。构成比的顺序从高到低依次为耐RFP(27.82%)、耐INH+RFP(17.29%)、耐INH+RFP+EMB+SM(9.02%)、耐INH+RFP+EMB+SM+OFX(9.02%)。结论应加强对耐多药患者筛查及治疗工作,尤其是重视病原学阳性男性、20~<40岁年龄组和复发患者耐多药诊疗工作。

Objective To understand the prevalence of drug resistance of pulmonary tuberculosis(TB)cases in Qinhuangdao from 2015-2019,and we provide scientific evidence for the treatment and prevention of drug resistance TB epidemic.MethodsThe 1095 cases of initial treated TB patients and retreated TB patients with positive pathogen were selected to conduct traditional drug sensitivity tests from Jan.2015-Dec.2019,and 1065 cases of Mycobacterium tuberculosis were identified.The proportion method was used to test the sensitivity of Mycobacterium tuberculosis to isoniazid(INH),rifampicin(RFP),ethambutol(EMB),streptomycin(SM),ofloxacin(OFX),kanamycin(KM).ResultsThe 133 cases were drug resistant in 1065 patients,and the total drug resistance rate was 12.49%.There were 73 cases of drug resistance in 910cases of initial treated patients,with a drug resistance rate 8.02%;and 60 cases of drug resistance in 155 cases of retreated patients,with a drug resistance rate 38.71%.The difference of resistance rates of initial treated patients and retreated patients were statistically significant(P<0.05).The resistance rates of the male patients and female patients were 12.64%and 12.03%respectively(P>0.05).The difference of drug resistance between five age groups was significant(P<0.05),and the drug resistance rate of 20~<40 age group was the highest(17.30%).The difference of the resistance rate to RFP,INH,SM,EMB and OFX between the initial treated patients and retreated patients was statistically significant(P<0.05)respectively.The Mycobacterium tuberculosis isolates presented 16 drug resistant spectra,including 52 cases of mono-drug resistance(4.88%),5 cases of poly-drug resistance(0.47%),76 cases of multi-drug resistance(7.14%).The predominant resistance modes were RFP resistance(27.82%),INH+RFP resistance(17.29%),INH+RFP+EMB+SM resistance(9.02%),and INH+RFP+EMB+SM+OFX resistance(9.02%).ConclusionQinhuangdao should enhance prevention and treatment work of drug resistance TB,especially male patients,20-age group and the retreated patients with positive pathogen.