结核分支杆菌的初始、获得性耐药及复治后MDR-TB研究

A Study on the Primary and Acquired Drug Resistance of Mycobacterium tuberculosis and the Conditions of Post-retreatment MDR

目的 :了解本地近 10年活动性结核病病人的初始、获得性耐药及复治后耐多药结核 (MDR -TB)分布情况 ,为临床制定有效抗结核方案、防痨机构流行病学调查及制定宏观控制方案提供参考。方法 :分临床及结核菌监测两部分。临床资料主要针对有流行病学意义的住院结核菌阳性病人 ,对不同地区及年龄段的结核菌阳性病人的治疗、预后、复治原因及死亡率作分析 ;耐药菌检测主要对门诊及住院病人的痰及其他标本作结核菌培养及NAP区分试验。结果 :住院活动性结核病人 96 0 5例 ,结核菌阳性 32 82例 ,占 34.16 % ,15～ 6 0岁年龄段占 85 %以上。复治结核菌阳性组合并症及药物毒副反应、死亡率均高于初治组 ;8984份标本作分支杆菌培养 ,阳性 36 97份 (41.15 % ) ;3373株结核菌作耐药监测 ,总耐药率 5 5 .70 % ,初始耐药 4 12株 ,占 12 .2 1% ;初始MDR -TB菌 15 4株 ,占初始耐药菌的 37 37%。复治菌株耐药率 4 3.4 9% ,复治MDR -TB菌 82 2株 ,占复治耐药菌的 5 6 .0 3%。结论 :临床工作中 ,结核菌阳性病人占 1/ 3左右 ,青壮年组占 85 %以上 ,复治及复治后组毒副反应及死亡率高。耐药率 10年来有逐年增高趋势 ,初始耐药及获得性耐药率均高于全国平均水平 ,并趋于MDR -TB。

Objective: To know the trend of primary and acquired drug resistance of Mycobacterium tuberculosis and the conditions of post-retreatment MDR during 1993-2002 and so as to provide the basis of principles for TB clinical treatment and the basis of programs for epidemiological survey on tuberculosis. Methods: Subjects were divided into clinic group and Mycobacterium tuberculosis (MTB) survey group. Clinic data of treatment, prognosis, cause of retreatment and mortality of all cases were analysed on inpatients with MTB. Sputa of outpatients and inpatients were subjected to MTB culture and NAP testing. Results: 9 605 cases were active tuberculosis, and 3 282 cases were Mycobacterium positive (34.16%), of which 15～60-years-old tuberculosis patients composed more than 85%. The complication rates, side effects of drugs, and mortality of tuberculosis in retreatment groups were higher than those of new tuberculosis cases. Among 8 984 MTB cultured cases, 3 697 cases were positive (41.15%). Of the 3 373 isolates that subjected to susceptibility test, the total drug resistance rate was 55.70%, of which 412 initial isolates were resistant. The resistance rate was 12.21% (412/ 3 373 ), and of that, 154 initial MDR-TB isolates occupied 37.37% (154/412). The resistance rate of isolates from retreatment cases was 43.49% (1 467/3 373), of which 822 isolates was MDR-TB. The resistance rate was 56.03% (822/1 467). Conclusion: MTB positive patients were about one-third of the clinical patients, and 15～60-years-old patients composed more than 85% of them.The side effects of drugs and mortality of tuberculosis in groups of retreatment and post retreatment were higher than those of new cases. The drug resistance rate was higher in 1993-2002 than before. The primary and acquired resistance rate here was higher than national resistance rate, and there is a tendency for drug resisitance to become MDR.