2018-2020年河南省761株结核分枝杆菌耐药性分析

Analysis of drug resistance of Mycobacterium tuberculosis of 761 isolates in Henan province in 2018-2020

目的分析河南省761株结核分枝杆菌耐药性监测结果,探讨结核菌的耐药情况,为制定科学合理的防治对策提供依据。方法选取2018-2020年河南省5个耐药监测项目点安阳、濮阳、新乡、鹤壁和焦作纳入的761例临床患者分离培养的结核分枝杆菌菌株,采用比例法进行异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星、卷曲霉素、丙硫异烟胺和对氨基水杨酸等9种抗结核药品的药物敏感性试验,分析药敏结果。结果761例肺结核患者中,男性570例,女性191例,平均(47.43±18.78)岁。761例患者的任一耐药率为30.22%,其中多耐药率7.88%,耐多药率6.44%,广泛耐药率0.66%;初治患者耐药率为26.86%,复治患者耐药率为46.88%,差异有统计学意义(χ^(2)=20.233,P<0.001);耐多药率、广泛耐药率复治患者均高于初治患者,差异有统计学意义(χ^(2)=38.715,P<0.001)。安阳、濮阳、新乡、鹤壁和焦作5地市的任一耐药率分别为36.00%、26.54%、26.14%、39.31%和23.84%,差异有统计学意义(χ^(2)=13.215,P<0.05)。结论5地市结核病耐药情况比较严峻,应进一步规范患者治疗,积极开展耐药监测和药敏试验,加强耐药结核病患者的发现和管理力度。

Objective To analyze the drug resistance test results of 761 clinical isolates of Mycobacterium tuberculosis(MTB) in Henan province, and explore the trends of MTB drug resistance so as to provide scientific basis for formulating scientific and reasonable prevention and control countermeasures. Methods A total of 761 clinical isolates of MTB cultured from 761 clinical patients in 5 prefectures from 2018 to 2020 were enrolled. The drug susceptibility test of isoniazid, rifampicin, ethambutol,streptomycin, kanamycin, ofloxacin, capreomycin, prothionamideand p-aminosalicylic acid was perfermed by proportion method,and the results were analyzed. Results Among the 761 patients, there were 570 males and 191 females, with an average age of(47.43±18.78) years. The overall drug resistance rate in the 761 patients was 30.22%, of which, poly-drug resistant TB(PDRTB), multi-drug resistant TB(MDR-TB) and extensive-drug resistant TB(XDR-TB) accounted for 7.88%, 6.44% and 0.66%,respectively. Drug-resistance rate in newly treated patients was 26.86% and 46.88% in retreated patients, with statistically significant difference(χ^(2)=20.233, P<0.001). MDR-TB rate and XDR-TB rate in retreated patients were higher than those in newly ones, with statistically significance(χ^(2)=38.715, P<0.001). The total drug resistance rates in Anyang, Puyang, Xinxiang, Hebi and Jiaozuo were 36.00%, 26.54%, 26.14%, 39.31% and 23.84%, respectively, with statistically significant difference being observed(χ^(2)=13.215, P<0.05). Conclusion The prevalence of drug resistance in clinical isolates of MTB is serious in the five prefectures of Henan province. The treatment of TB patients should be further standardized,and drug resistance surveillance and drug susceptibility test should be actively carried out to strengthen the detection and management of drug-resistant TB patients.