肺结核患者分枝杆菌耐药谱及耐药性研究

Study on the Drug Resistance Spectrum and Drug Resistance of Mycobacteria in Patients with Pulmonary Tuberculosis

目的研究深圳光明区肺结核患者的分枝杆菌耐药谱及耐药性。方法方便选取2019年1—12月光明区该院收治的294例初治肺结核患者与27例复治肺结核患者为研究对象,对所有患者的抗酸染色阳性痰标本予以分枝杆菌分离培养及菌种鉴定,321株结核分枝杆菌对乙胺丁醇、利福平、异烟肼及链霉素的敏感性选取浓度比例法进行检测,结核分枝杆菌优势耐药模式选取统计学方法进行分析。结果321株分枝杆菌中,结核分枝杆菌占比为97.51%(313/321),非结核分枝杆菌占比为2.49%(8/321)。初治肺结核患者的非结核分枝杆菌感染率明显低于复治肺结核患者,差异有统计学意义(P<0.05)。与初治肺结核患者比较,复治肺结核患者的结核分枝杆菌对4种抗结核药物的耐药率更高,差异有统计学意义(P<0.05)。结论初治肺结核患者的结核分枝杆菌耐药性、非结核分枝杆菌感染率明显低于复治肺结核患者,提示光明区肺结核患者抗结核药物的使用合理性、规范性还有待进一步加强。

Objective To study the drug resistance spectrum and drug resistance of mycobacteria in pulmonary tuberculosis patients in Guangming District,Shenzhen.Methods Conveniently selected 294 newly treated pulmonary tuberculosis patients and 27 retreated pulmonary tuberculosis patients who were admitted to the hospital in Guangming District from January to December 2019 as the research object.The acid-fast stain-positive sputum samples of all patients were isolated and cultured with mycobacteria species identification,the sensitivity of 321 Mycobacterium tuberculosis strains to ethambutol,rifampicin,isoniazid and streptomycin was tested by the concentration ratio method,and the dominant drug resistance mode of Mycobacterium tuberculosis was analyzed by statistical methods.Results Among the 321 strains of mycobacteria,Mycobacterium tuberculosis accounted for 97.51%(313/321),and non-tuberculous mycobacteria accounted for 2.49%(8/321).The infection rate of nontuberculous mycobacteria in newly treated pulmonary tuberculosis patients was significantly lower than that in retreated pulmonary tuberculosis patients,the difference was statistically significant(P<0.05).Compared with newly treated pulmonary tuberculosis patients,Mycobacterium tuberculosis in retreated pulmonary tuberculosis patients had a higher drug resistance rate to the four anti-tuberculosis drugs,the difference was statistically significant(P<0.05).Conclusion The drug resistance and non-tuberculous mycobacterial infection rate of newly treated pulmonary tuberculosis patients is significantly lower than that of retreated pulmonary tuberculosis patients,suggesting that the rationality and standardization of the use of anti-tuberculosis drugs in pulmonary tuberculosis patients in Guangming District needs to be further strengthened.