231例结核分枝杆菌培养阳性肺结核患者的耐药情况分析

Analysis on the drug resistance in 231 cases with positive Mycobacterium tuberculosis culture

目的:分析231例结核分枝杆菌(MTB)培养阳性肺结核患者的耐药情况,为皖南地区制定合理的抗结核治疗方案提供科学依据。方法:选取2017年12月~2019年12月弋矶山医院收治的231例MTB培养阳性肺结核患者为研究对象,并进行4种一线抗结核药物(异烟肼、利福平、链霉素、乙胺丁醇)的药物敏感性试验,对其结果进行分析。同时根据结核感染T细胞斑点试验(T-SPOT.TB)检测结果,对耐药组和敏感组进行分析。结果:所有患者的总耐药率为27.27%,初治组总耐药率22.63%,复治组总耐药率48.78%,差异有统计学意义(P<0.05)。初治组单耐药率和多耐药率为16.84%和2.11%,复治组单耐药率和多耐药率为17.07%和4.88%,差异无统计学意义(P>0.05);初治组中耐多药率3.68%,复治组中耐多药率26.83%,差异有统计学意义(P<0.05)。T-SPOT.TB值在耐药组和敏感组间的差异无统计学意义(P>0.05)。结论:皖南地区肺结核尤其是耐药结核形势不容乐观,复治患者要合理选用抗结核药,提高疗效的同时,减少耐药的产生。

Objective:To analyze the drug resistance in 231 tuberculosis cases with positive Mycobacterium tuberculosis culture for scientific evidence to plan rational anti-tuberculosis treatment in population in southern Anhui Province.Methods:231 tuberculosis patients with culture-positive Mycobacterium tuberculosis were enrolled in our hospital from December 2017 to December 2019,and underwent drug sensitivity test using the first-line anti-tuberculosis drug isoniazid,rifampicin,streptomycin and ethambutanol.The results,together with the findings of T-cell spot test of tuberculosis infection(T-SPOT.TB),were analyzed in the drug resistance group and the sensitive group.Results:The total tolerance rate was 27.27%for all patients,and 22.63%and 48.78%,respectively for patients undergone initial treatment and repeated treatment(both P<0.05).The rate of single drug resistance and multidrug resistance was 16.84%and 2.11%in the initial treatment group,and 17.07%and 4.88%in the retreatment group.The difference was insignificant(P>0.05).Multi-drug tolerance occurred in 3.68%of the patients in initial treatment group and in 26.83%of those in the repeated treatment group(P<0.05).There was no significant difference in T-SPOT.TB between drug-resistant and sensitive groups(P>0.05).Conclusion:The situation of tuberculosis,especially drug-resistant tuberculosis,appears not optimistic in patients living in southern Anhui area.The findings suggest that anti-tuberculosis drugs should be reasonably chosen in order to improve the efficacy and reduce the emergence of drug resistance.