西藏自治区结核病耐药性基线调查结果分析

Baseline investigation results of tuberculosis drug resistance in Tibet Autonomous Region

目的 全面了解西藏自治区耐药结核病流行现状和特点,为制定和完善当地耐药结核病防控措施提供依据。方法 收集2019年5月1日—2020年4月30日西藏自治区7个地市各级结防机构登记涂阳肺结核患者作为调查对象,以酸性改良罗氏培养法进行痰培养,采用对硝基苯甲酸和噻吩二羧酸肼(pnitrobenzoic acid-thiophene-2-carboxylic acid hydrazide,PNB-TCH)培养基进行分枝杆菌菌种鉴定,利用比例法进行4种一线、5种二线抗结核药物敏感性试验,并对不同特征患者的耐药率情况和耐药谱进行统计分析。结果 收集的579例肺结核患者痰样本,阳性554例,其中非结核分枝杆菌7例,最终纳入耐药分析547例。西藏自治区涂阳肺结核患者总耐药率达23.58%,耐多药率为7.68%,初治和复治患者的总耐药率分别为16.67%和61.18%,差异有统计学意义(χ^(2)=78.921, P<0.01),耐多药率分别为1.73%和40.00%,差异有统计学意义(χ^(2)=148.316,P<0.01)。耐药谱共有39种类型,其中单耐药9种、多耐药10种、耐多药20种。结论 西藏自治区结核总耐药率低于全国平均水平,但耐药结核病防控形势不容乐观,应加强耐药监测,提高诊疗水平,有效控制耐药结核病的传播。

Objective To comprehensively understand the epidemic status and characteristics of drug-resistant tuberculosis in Tibet Autonomous Region,so as to provide evidence for formulating and improving local prevention and control measures for drug-resistant tuberculosis.Methods Patients with smear-positive pulmonary tuberculosis registered in 7 prefectural and municipal anti-tuberculosis institutes of Tibet Autonomous Region in the period from May 1,2019 to April 30,2020 were collected.The sputum was cultured using Lowenstein-Jensen modified culture method,and strains of Mycobacteria were identified using p-nitrobenzoic acid-thiophene-2-carboxylic acid hydrazide(PNB-TCH)culture medium.The susceptibility test of 4 first-line and 5 second-line anti-tuberculosis drugs was carried out using resistance ratio method.Drug resistance rate and drug resistance spectrum in patients with different characteristics were analyzed.Results Of the collected 579 smear-positive specimens,554 showed positive culture results,including 7 Nontuberculous mycobacteria cases.The remaining 547 cases were finally included in drug resistance analysis.The total drug resistance rate of smear-positive pulmonary tuberculosis patients in Tibet reached 23.58%,and the proportion of multi-drug resistance was 7.68%.The total drug resistance rates of the initially treated and retreated patients were 16.67%and 61.18%(χ^(2)=78.921,P<0.01),respectively;and the multi-drug resistance rates were 1.73%and 40.00%(χ^(2)=148.316,P<0.01),respectively,both with statistically significant differences.There were 39 types of drug resistance spectrum,included 9 types of mono-resistance,10 types of polyresistance,and 20 types of multi-drug resistance.Conclusion The total drug resistance rate of tuberculosis in Tibet Autonomous Region is lower than the national average level,but with severe drug resistance.It is necessary to strengthen drug resistance monitoring and improve the level of diagnosis and treatment,in order to effectively control the spread of drug resistant tuberculosis.