北京市结核病防治机构复治结核病患者耐药情况分析

Analysis of drug resistance of retreated tuberculosis patients in Beijing prevention and control institutions

目的掌握北京市结核病防治机构复治结核病患者耐药情况。方法对2017年1月至2019年12月就诊于北京市各个区县结核病防治机构的复治结核病患者的临床分离株先使用分子线性探针技术快速筛查出耐多药(multidrug-resisitant,MDR)结核分枝杆菌菌株,之后对所有菌株进行比例法药物敏感性实验。结果复治患者MDR率为29.9%(40/134),非复发复治患者的MDR率高于复发患者(39.3%vs 23.1%),差异有统计学意义(χ^(2)=4.090,P<0.05)。耐药菌株中,利福平耐药以rpoB基因S531L位点突变为主(63.0%),异烟肼耐药70.5%为katG基因S315T1位点发生突变。比例法药敏结果显示复发患者耐药率为57.7%,非复发患者耐药率为53.1%。结论北京市复治患者的耐药率较高,特别是非复发的复治患者MDR率需要引起重视,详细的药物敏感性实验结果对复治结核病的治疗至关重要。

Objective To understand the drug resistance of tuberculosis in retreated patients in Beijing.Methods An investigation was conducted on retreated pulmonary tuberculosis patients in Beijing from January 2017 to December 2019.The molecular line probe method was used to quickly detect multidrug-resistant(MDR)Mycobacterium tuberculosis strains.Then all strains were tested for drug sensitivity by proportional method.Results The MDR rate of retreated patients was 29.9%(40/134),the MDR rate of non-recurrent retreated patients was higher than that of recurrent patients(39.3%vs 23.1%),and the difference was statistically significant(χ^(2)=4.090,P<0.05).Among the resistant strains,rifampicin resistance was mainly caused by mutations at S531L in the rpoB gene(63.0%),and 70.5%of isoniazid resistance was caused by mutations at S315T1 in the katG gene.The proportional method drug susceptibility results showed that the drug resistance rate of recurrent patients was 57.7%,and that of non-recurrent patients was 53.1%.Conclusion The drug resistance rate of retreated patients in Beijing is high,especially the MDR rate of non-recurrent retreated patients needs to be paid more attention.Detailed drug-testing results are essential for the treatment of retreated tuberculosis.