高海拔地区结核分枝杆菌耐药特征研究

Study on drug resistance of Mycobacterium tuberculosis circulating in high altitude area

目的研究高海拔地区1531株结核分枝杆菌(Mycobacterium tuberculosis,MTB)耐药特征,为高海拔地区耐药结核病防控提供科学依据。方法收集青海省1531株MTB,采用比例法对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、卡那霉素(KM)、氧氟沙星(OFX)6种常用抗结核药物进行药物敏感性试验,并对结果进行统计分析。结果1531株MTB总耐药率32.98%(505/1531),单耐药率12.34%(189/1531),多耐药率5.75%(88/1531),耐多药率14.89%(228/1531),广泛耐药率1.1%(17/1531),利福平耐药率18.16%(278/1531),不同地区不同类型耐药率差异均有统计学意义(均P<0.05)。复治患者总耐药率、利福平耐药率高于初治患者(χ^(2)_(总耐药率)=505.00,P<0.01;χ^(2)_(利福平耐药率)=278.00,P<0.05),差异有统计学意义。分离的菌株对6种抗结核药物中的一种耐药率由高到低依次为:INH、SM、RFP、EMB、OFX、KM。单耐药谱以单耐SM占比最高;多耐药谱有7种类型,同时耐INH、SM占比最高;耐多药谱有16种类型,同时耐INH、RFP、SM、EMB占比最高。人群特征来看,总耐药率男性高于女性;青年组高于中、老年组;民族由高到低依次为汉族、回族、其他民族、藏族,差异均有统计学意义(均P<0.05)。结论青海省耐药结核病高于全国水平,可能与本地区高寒缺氧、耐药结核病诊治医疗资源有限等有关,今后的工作应加强政府承诺,加强耐药结核病的发现和治疗,尤其是初治患者的耐药检测。

To study the drug resistance status of 1531 Mycobacterium tuberculosis(MTB)strains from high altitude area and thus to provide scientific basis for the prevention and control of drug-resistant tuberculosis(DR-TB).1531 strains MTB were collected from Qinghai Province,and the proportional method was used to test drug sensitivity of 6 anti-tuberculosis drugs(isoniazid,rifampicin,ethambutol,streptomycin,kanamycin,ofloxacin)commonly used clinically and data were analyzed statistically.The rates fortotal drug resistant(TDR-TB),mono-resistant(MR-TB),poly-resistant(PDR-TB),multidrug-resistant(MDR-TB),extensively drug-resistant(XDR-TB),and rifampicin-resistant(RR-TB)were 32.98%(505/1531),12.34%(189/1531),5.75%(88/1531),14.89%(228/1531),1.1%(17/1531),18.16%(278/1531)respectively.The DR rate of different types in different areass were statistically different(P<0.05).The TDR-TB and RR-TB in retreated patients were higher than initial treated patients(χ^(2)_(TDR)=505.00,P<0.01;χ^(2)_(RR)=278.00,P<0.05).The resistance rates of six anti-tuberculosis drugs from high to low were INH,SM,RFP,EMB,OFX and KM.By the spectrum of mono-resistance,SM was the highest.By the spectrum of PDR-TB,7 types were found and concurrently resistant to both INH and SM was the highest.By the spectrum of MDR-TB,16 types were found and concurrently resistant to INH,RFP,SM and EMB was the highest.By population characteristics,the total drug-resistant rate in female was higher than male,in youth group was higher than middle and old age groups,in different minorities from high to low were Han,Hui,others and Tibetan were statistically different(P<0.05).The DR-TB of Qinghai Province is higher than the national level,which may be related to cold and hypoxia harsh environment,and limited medical resources for the diagnosing and treating drug-resistant tuberculosis.So the government’s commitment should be fulfilled and detection and treatment of DR-TB should be strengthened,especially newly treated patients.