2015—2019年湖北省荆州市肺结核患者一线抗结核药品耐药分析

Analysis of drug resistance of first-line anti tuberculosis drugs in Jingzhou City of Hubei Province from 2015 to 2019

为了解湖北省荆州市肺结核患者对一线抗结核药品的耐药情况,笔者选取2015年1月至2019年12月湖北省荆州市胸科医院分离的2681株结核分枝杆菌复合群菌株,应用BACTEC MGIT 960系统检测其对4种一线抗结核药品(链霉素、异烟胼、利福平、乙胺丁醇)的耐药情况。结果显示,菌株总耐药率为28.87%(774/2681),2015—2019年各年度分离株总耐药率[分别为31.55%(147/466)、32.52%(159/489)、30.84%(165/535)、25.04%(151/603)、25.85%(152/588)]及各年度复治患者分离株总耐药率[分别为60.13%(92/153)、55.94%(80/143)、59.71%(83/139)、42.67%(64/150)、51.38%(56/109)]均随时间呈现下降趋势,差异均有统计学意义(χ^(2)趋势=12.716,P=0.013;χ^(2)趋势=12.418,P=0.014)。菌株总耐多药率为12.23%(328/2681),初治和复治患者分离株耐多药率分别为5.49%(109/1987)和31.56%(219/694)。各年度初治患者耐药分离株和耐多药分离株在总耐药菌株中的构成比[分别为37.41%(55/147)、49.69%(79/159)、49.70%(82/165)、57.62%(87/151)、63.16%(96/152);24.29%(17/70)、26.67%(16/60)、32.35%(22/68)、33.33%(21/63)、49.25%(33/67)]均随时间呈明显升高趋势,差异有统计学意义(χ^(2)趋势=22.632,P<0.01;χ^(2)趋势=11.466,P=0.022)。菌株耐药顺位依次为异烟肼[20.51%(550/2681)]、链霉素[18.99%(509/2681)]、利福平[14.77%(396/2681)]、乙胺丁醇[7.83%(210/2681)]。

To investigate the drug resistance to first-line anti-tuberculosis drugs among tuberculosis patients in Jingzhou City,Hubei Province,a total of 2681 samples preliminarily identified as Mycobacterium tuberculosis were tested with BACTEC MGIT 960 for 4 first-line anti-tuberculosis drugs(streptomycin:S,isoniazide:H,rifampicin:R and ethambutol:E).The results demonstrated that the total drug resistance rate was 28.87%(774/2681).The total drug resistance rates among all patients(from 2015 to 2019,31.55%(147/466),32.52%(159/489),30.84%(165/535),25.04%(151/603)and 25.85%(152/588),respectively)and among retreatment patients(from 2015 to 2019,60.13%(92/153),55.94%(80/143),59.71%(83/139),42.67%(64/150),51.38%(56/109),respectively)both demonstrated a downward tendency over time,differences were statistically significant(χ^(2)trend=12.716,P=0.013;χ^(2)trend=12.418,P=0.014).The total multi-drug resistance rate of isolates was 12.23%(328/2681),which were 5.49%(109/1987)and 31.56%(219/694)among newly treated and retreated patients respectively.The proportion of drug-resistant isolates from newly treated patients and multidrug-resistant isolates within all drug-resistant isolates(from 2015 to 2019,the former were 37.41%(55/147),49.69%(79/159),49.70%(82/165),57.62%(87/151),63.16%(96/152);the latter were 24.29%(17/70),26.67%(16/60),32.35%(22/68),33.33%(21/63),49.25%(33/67),respectively)all demonstrated an increasing tendency over time,differences were statistically significant(χ^(2)trend=22.632,P<0.01;χ^(2)trend=11.466,P=0.022).The order of drugs with higher proportion of drug resistance were isoniazid(20.51%(550/2681)),streptomycin(18.99%(509/2681)),rifampicin(14.77%(396/2681)),ethambutol(7.83%(210/2681))in sequence.