2020年四川省涂阳结核病初复治患者耐药情况分析

Analysis of drug resistance in initial retreatment patients with smear-positive Tuberculosis in Sichuan Province in 2020

目的了解四川省2020年涂阳结核病初复治患者结核分枝杆菌耐药状况,为预防和控制耐药结核病提供基础科学依据。方法在四川省选择21个县(区)做结核耐药监测点,对2020-01/12期间纳入的涂阳痰标本进行分离培养,并采用PNB培养法对分离培养得到的分枝杆菌进行鉴定,用比例法对结核分枝杆菌进行RFP、INH、EMB、SM、KM、OFX的药物敏感性试验,并对其结果进行分析。结果 1 025例纳入分析的患者中,NTM占总体患者的4.20%,最终纳入耐药分析的例数为982例,其中初治患者870例,复治患者112例。总耐药率为18.74%,初治耐药率17.82%,复治耐药率25.89%,耐多药率为3.67%,初治耐多药率3.10%,复治耐多药率8.04%,检测的6种药物任意耐药率顺位从高到低依次为INH>SM>OFX>RFP>EMB>KM。结论四川省结核病耐药情况依然严峻,应当加强结核病防治政策的推进落实,减少耐药结核病的传播;加强结核病的规范化治疗和对患者的管理,降低结核病的复发和减少耐药的产生。

Objective To investigate the drug resistance of mycobacterium tuberculosis in initial retreatment patients with smear-positive tuberculosis in Sichuan province in 2020, and to provide basic scientific basis for the prevention and control of drug-resistant tuberculosis. Methods Twentyone counties(districts) in Sichuan province were selected as TB drug resistance surveillance sites.Smear positive sputum specimens included during January to December 2020 were isolated and cultured,and mycobacterium isolates were identified by proportion method. Drug sensitivity tests of RFP, INH, EMB, SM, KM and OFX were performed for Mycobacterium tuberculosis. Then the data was analyzed. Results Among 1 025 patients included in the analysis, NTM accounted for4.20% of the total patients. The final number of cases included in the drug resistance analysis was982 cases, including 870 cases of initial treatment and 112 cases of retreatment. The total drug resistance rate was 18.74%,the initial drug resistance rate was 17.82%,the relapse drug resistance rate was 25.89%,the multidrug resistance rate was 3.67%,the initial multidrug resistance rate was3.10%,and the relapse multidrug resistance rate was 8.04%. The random drug resistance rate of the6 drugs was INH>SM>OFX>RFP>EMB>KM from high to low. Conclusions The situation of TB resistance in Sichuan province is still severe. It is necessary to strengthen the implementation of TB prevention and control policies to reduce the spread of drug-resistant TB. Standardized treatment of TB and patient management should be strengthen to reduce TB recurrence and drug resistance.