2009-2018年北京市怀柔区耐药监测点肺结核患者的耐药分析

Analysis on the drug resistance of tuberculosis patients at surveillance sites in Huairou district of Beijing,2009-2018

目的通过对北京市怀柔区耐药监测点药敏结果的分析,了解怀柔区肺结核患者的耐药情况,为结核病的防治工作提供参考。方法选取2009-2018年北京市怀柔区耐药监测点全部培养阳性肺结核患者的临床分离株进行体外固体药物敏感性实验(drug susceptibility test,DST),并对实验结果进行回顾性研究分析。同时对比例法DST结果提示对异烟肼(INH)或利福平(RFP)产生耐药的菌株进行MTBDR plus检测。计数资料采用χ^(2)检验,P<0.05为差异有统计学意义。结果MTB临床分离株中任何耐药率为33.62%,单耐药率为7.66%,多耐药率为8.09%,耐多药率为10.21%,准广泛耐药率为2.98%,广泛耐药率为0.85%,RFP耐药率为11.91%。其中,复治患者的耐多药、准广泛耐药和RFP耐药的耐药率都明显高于初治患者(χ^(2)分别为21.25、13.39和21.34,P均<0.05);女性患者的任何耐药率高于男性患者(χ^(2)=5.05,P<0.05);20~60岁年龄段耐多药和RFP耐药的耐药率最高。2009-2018年,耐药结核分离株比例变化不大,保持在小范围内波动。MTBDR plus检测提示INH最主要的突变发生在katG基因的S315T1位点(22/35,62.86%),RFP最主要的突变发生在rpoB基因的S531 L位点(15/24,62.50%)结论北京市耐药监测地区结核病耐药疫情仍然严峻,应对耐多药和利福平耐药患者加强管控。

Objective Through the analysis of the tuberculosis drug susceptibility of drug resistance surveillance sites in Huairou district of Beijing,we conclude the drug resistance situation of tuberculosis patients in Huairou district and provide recommendations for the prevention and treatment of tuberculosis.Methods All culture positive isolated strains from pulmonary tuberculosis patients were selected from 2009-2018 in Huairou district of Beijing,and the solid proportional drug susceptibility testing(DST)were applied;and the result were analyzed in a retrospective study.The MTBDR plus test was also performed on the strains whose DST result suggested drug resistance to INH and RFP by the proportional method.Chi-square analysis was used for counting data,when P<0.05,the difference was statistically significant.Results Among the 235 clinical isolates,the any-drug resistance rate was 33.62%,mono-drug resistance rate was 7.66%,poly-drug resistance rate was 8.09%,multidrugresistance rate was 10.21%,and Pre-XDRTB resistance rate was 2.98%,the extensive-drug resistance rate was 0.85%,the RFP drug resistance rate was 11.91%.In addition,multidrug-resistant,Pre-XDRTB and rifampicin-resistance in retreated patients were significantly higher than those in initially-treated patients(χ^(2)=21.25,13.39 and 21.34,respectively,all P<0.05);any type of drug-resistance of female patients are higher than that in male patients(χ^(2)=5.05,P<0.05);the multi-drug resistance and RFP resistance were highest in the age group between 20-60 years age group.During 2009-2018,the proportion of isolates resistant to anti-TB drugs fluctuated from year to year,but remained within a narrow range of values.MTBDR plus testing suggested that the most predominant mutation in INH occurred at the S315T1 site of the katG gene(22/35,62.86%),and the most predominant mutation in RFP occurred at the S531 L site of the rpoB gene(15/24,62.50%).Conclusions Tuberculosis drug resistance epidemic situation is severe in Beijing’s drug resistance surveillance area,and the control of multidrug-resistant tuberculosis and rifampicin-resistant tuberculosis patients should be strengthened.