新疆喀什地区331株结核分枝杆菌耐药情况分析

Analysis on drug resistance of 331 strains of Mycobacterium tuberculosis in Kashgar area of Xinjiang

目的分析新疆喀什地区结核分枝杆菌的耐药情况,为制定新疆喀什地区结核病控制策略提供依据。方法收集2017年1月—2019年12月来自喀什肺科医院和新疆维吾尔自治区胸科医院结核分枝杆菌培养阳性且现住址属于喀什地区肺结核患者的菌株,通过噻吩-2-羧酸肼(TCH)/对硝基苯甲酸(PNB)鉴别培养基排除非结核分枝杆菌和牛型结核分枝杆菌,最终获得331株感染人型结核分枝杆菌病例。采用比例法药物敏感性试验检测331株人型结核分枝杆菌对16种抗结核药物的耐药性。结果 331株分离菌株的单耐药患者共56例,单耐药率为16.9%;多耐药患者共20例,多耐药率为6.0%;耐利福平患者共61例,利福平耐药率为18.4%;耐多药患者共25例,耐多药率为7.6%;广泛耐药患者5例,广泛耐药率为1.5%。其中复治组单耐药率(23.2%)和利福平耐药率(28.2%)均显著高于初治组(12.2%和11.1%)(均P<0.05),<30岁年龄组耐多药率(16.7%)显著高于30~<60岁、≥60岁两组(4.9%和7.2%)(P<0.05)。对16种抗结核药物的耐药顺位为异烟肼(INH)>利福平(RFP)>链霉素(Sm)>左氧氟沙星(Lfx)>利福喷丁(Rft)>莫西沙星(Mfx)>乙胺丁醇(EMB)>卡那霉素(KAN)>利福布汀(Rfb)>阿米卡星(Am)>力克肺疾(PI)>克拉霉素(Clr)>卷曲霉素(Cm)>对氨基水杨酸(PAS)>丙硫异烟胺(Pto)>氯法齐明(Cfz)。耐药谱有32种类型,其中单耐药3种,多耐药17种,耐多药12种(其中包括广泛耐药5种)。结论新疆喀什地区结核分枝杆菌耐药状况较为严重,耐多药率呈上升趋势,耐药谱呈现复杂性和多样性。应规范临床用药及早发现耐药结核病患者并提供有效的个性化治疗,以防止原发性耐药结核病的广泛传播。

Objective To analyze the drug resistance of Mycobacterium tuberculosis in Kashgar area of Xinjiang,provide the basis for the development of tuberculosis control strategy in Kashgar area of Xinjiang. Methods The strains of tuberculosis patients from the Kashgar Pulmonary Hospital and Chest Hospital of Xinjiang Autonomous Region,whose Mycobacterium tuberculosis culture result is positive and current address belongs to Kashgar area,were collected from January 2017 to December 2019. The differential medium of thiophen-2-carboxylic acid hydrazine(TCH) and p-nitrobenzoic acid(PNB) was used to exclude the nontuberculous Mycobacterium and Mycobacterium bovis,and 331 strains of Mycobacterium tuberculosis hominis were eventually obtained. The proportional method was used for the drug susceptibility test of 16 anti-tuberculosis drugs in 331 strains of Mycobacterium tuberculosis hominis. Results Among 331 strains,there were 56 cases of mono-resistant tuberculosis and 20 cases of poly-resistant tuberculosis,with the mono-resistant rate and poly-resistant rate of 16.9% and 6.0% respectively. 61 patients were resistant to rifampicin with the drug resistance rate of 18.4%. There were 25 cases of multi drug-resistant tuberculosis,with the multi drug-resistant rate of 7.6%. There were 5 cases of extensively drug-resistant tuberculosis,with the extensively drug-resistant rate of 1.5%. The mono-resistant tuberculosis rate(23.2%) and and rifampicin-resistant tuberculosis rate(28.2%) of retreatment group were significantly higher than those of the initial treatment group(both P<0.05). The multidrug-resistant tuberculosis rate of <30 age group was significantly higher than that of 30-<60 and ≥60 groups(4.9% and 7.2%)(P<0.05). The sequence of drug resistance to 16 antituberculosis drugs was as follows:isoniazid(INH)>rifampicin(RFP)>streptomycin(Sm)>levofloxacin(Lfx)>rifapentine(Rft)>moxifloxacin(Mfx)>ethambutol(EMB)>kanamycin(KAN)>rifabutin(Rfb)>amikacin(Am)>pasiniazid(PI)>clarithromycin(Clr) >capreomycin(Cm) >p-aminosalicylic acid(PAS) >propylthioisonicotinamide(Pto) >clofazimine(Cfz). The Mycobacterium tuberculosis isolates presented 32 drug-resistant spectra,including 3 cases of mono-drug resistance,17 cases of poly-drug resistance,12 cases of multi-drug resistance(including 5 cases of extensively drug-resistance). Conclusion The drug resistance of Mycobacterium tuberculosis in Kashgar area of Xinjiang is relatively serious,the multidrug-resistant tuberculosis rate is on the rise,and the drug resistance spectrum presents complexity and diversity. It is necessary to standardize clinical medication to detect drug-resistant tuberculosis patients as early as possible and provide effective individualized treatment,to prevent the spread of primary drug-resistant tuberculosis.