Prevalence of Mycobacterium tuberculosis Strains Isolated from Both Pulmonary and Extra Pulmonary Samples and Their Resistance to Rifampicin: A Study from Kolkata and Surrounding Suburbs

Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. In India, nearly 1.8 million new cases of TB are reported annually, which accounts for a fifth of new cases in the world—greater than in any other country. Anti-tubercular drugs (ATDs) have been used for decades, and widespread resistance to them is a very serious public health concern in any part of the world. Aim of this study was to determine the prevalence of Rifampicin (the first line Anti-TB drug) resistance among both pulmonary and extra-pulmonary samples tested positive for Mycobacterium tuberculosis and thereby predict the prevalence of Multi-drug resistant (MDR) tuberculosis in Kolkata and its Suburban regions. All 331 randomly collected clinical samples (both Pulmonary and Extra Pulmonary) were initially screened by Zeihl-Neelsen AFB staining followed by culture on BacT/Alert 3D system and on Lowenstein-Jensen medium and the positive samples were subjected to detection of Mycobacterium tuberculosis complex (MTBC) and simultaneous analysis of Rifampicin resistance by Xpert MTB/RIF assay. Out of the 51 (15.40%) culture positive samples, 13.7% of pulmonary samples and 9.09% of extra-pulmonary samples were Rifampicin resistant. The prevalence of Rifampicin resistant TB in our study is high and the possible reasons can be mixing of new as well as retreatment cases and smaller sample size but, yet it can help Government and public health regulatory bodies to formulate adequate strategies to fight against drug resistant tuberculosis, especially in this part of the world.

Natural Remedies against Multi-Drug Resistant <i>Mycobacterium tuberculosis</i>

Tuberculosis (TB), caused by Mycobacterium tuberculosis is an infectious deadly disease and the treatment of which is one of the most severe challenges at the global level. Currently more than 20 chemical medications are described for the treatment of TB. Regardless of availability of several drugs to treat TB, the causative agent, M. tuberculosis is nowadays getting resistant toward the conventional drugs and leading to conditions known as Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). This situation has terrified the global health community and raised a demand for new anti-tuberculosis drugs. Medicinal plants have been used to cure different common as well as lethal diseases by ancient civilizations due to its virtue of variety of chemical compounds which may have some important remedial properties. The aim of the present review is to focus the anti-tubercular medicinal plants native to India as well as the plants effective against MDR or XDR-TB across the globe. In the present review, we have addressed 25 medicinal plants for TB and 16 plants effective against MDR-TB testified from India and 23 herbal plants described for MDR-TB across the world during 2011-2015. These herbal plants can serve as promising candidates for developing novel medications to combat multidrug resistant M. tuberculosis.

Identification, Synthesis, Isolation and Spectral Characterization of Multidrug-Resistant Tuberculosis (MDR-TB) Related Substances

Several related substances were detected at trace level in (2R)-2,3-dihydro-2-methyl-6-nitro-2-[[4-[4-[4-(trifluoromethoxy)phenoxy]-1-piperidinyl] phenoxy] methyl]imidazo[2, 1-b]oxazole drug substance by a newly developed high-performance liquid chromatography method. All related substances were characterized rapidly but some impurities were found to be intermediates. Proposed structures were further confirmed by characterization using NMR, FT-IR, and HRMS techniques. Based on the spectroscopic data;unknown related sub-stances were characterized as 1-(Methylsulfonyl)-4-[4-(trifluoromethoxy) phenoxy]piperidine;4-{4-[4-(Tri-fluoromethoxy)-phenoxy]piperidin-1-yl}phenol and 4-{4-[4-(trifluoromethoxy)phenoxy]piperidin-1-yl}phenyl methane sulfonate;4-Bromophenyl methane sulfonate, Ethyl 3,6-dihydro-1(2H)-pyridine carboxylate, (2S)-3-(4-Bromophenoxy)-2-hydroxy-2-methylpropyl methane sulfonate, (2S)-3-(4-Bromophenoxy)-2-methylpropane-1,2-diyldimethane-sulfonate, (2S)-2-Methyl-3-(4-{4-[4-(trifluoromethoxy) phenoxy]-piperidin-1-yl} phenoxy)-propane-1,2-diyldimethane sulfonate, (S)-3-(4-Bromophenoxy)-2-methyl-propane-1,2-diol and corresponding Enantiomer, (2R)-2-[(4-Bromo-phenoxy)methyl]-2-methyloxirane and (2R)-2-[(4-bromophenoxy)methyl]-2-methyl-6-nitro-2,3-dihydroimidazo[2,1-b][1,3]oxazole. A possible mechanism for the formation of these related substances is also proposed.

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

Objective To investigate the prevalence of primary drug-resistant tuberculosis（TB） and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis（MDR-TB）. Methods A total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. Results Among 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75（80.6%） isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65（69.9%） isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine（31.2%） primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531 L rpoB mutation. Conclusion This study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

Determinants of Persistent Sputum Smear Positivity after Intensive Phase Chemotherapy among Patients with Tuberculosis at Rhodes Chest Clinic, Nairobi, Kenya

The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.

MTBDRplus技术快速检测结核分枝杆菌耐多药的临床应用评价

目的评价线性探针杂交技术(简称MTBDRplus技术)对福州地区耐药结核杆菌的检测效果,并了解该地区耐药结核分枝杆菌的耐药基因特征。方法选取246株临床结核分枝杆菌分离株,以传统罗氏药敏试验为金标准,评价MTBDRplus技术在临床上应用的检测效果,分析耐药基因突变分布频率。结果与传统罗氏药敏试验相比较,MTBDRplus检测利福平(RIF)和异烟肼(INH)耐药性灵敏度分别为91.7%(11/12)和83.3%(15/18),MTBDRplus检测RIF和INH耐药性特异度分别为99.6%(233/234)和95.2%(217/228)。12例rpoB基因存在突变的结核分枝杆菌中,58.3%rpoB基因S531L突变;26例katG和inhA基因存在突变的结核分枝杆菌中,57.7%(15/26)katG基因315突变;存在C15T位点突变的菌株仅9.1%(1/11)为INH耐药菌株。结论 MTBDRplus技术是一个敏感、特异的快速诊断耐多药结核病的有效方法,该技术在福州地区具有较好的应用前景。福州市耐药结核分枝杆菌以rpoB S531L和katG S315T突变型为主。建议谨慎判断结核分枝杆菌inhA基因C15T位点突变引起的INH耐药。

乙肝合并结核分枝杆菌感染患者的结核耐药基因分布情况

目的:探讨结核病(TB)/慢性乙型肝炎病毒(HBV)合并感染患者对一线抗结核药物耐药的频率和分子机制。方法:研究对来自TB/HBV共感染患者的100株结核分枝杆菌菌株进行了回顾性实验室分析,其中Beijing谱系株最为普遍(49%),其次是EAI谱系株(35%),少数菌株包括Haarlem(2.0%)、LAM(1.0%)、MANU(3.0%)、T(4.0%)和U(6.0%)。所有菌株均于2014年至2018年从患者的痰、胸腔积液标本中分离。对所有菌株进行药敏试验、Spoligotyping分型和24个位点穿插重复单元(MIRU-24分型),并对rpoB、katG、inhA和inhA启动子、rpsL、rrs和embB基因进行测序。结果:总共有42株(42.0%,42/100)菌株表现出耐药性;9株(9.0%,9/100)是多重耐药株(MDR)。对异烟肼的耐药率为25.0%(25/100),利福平的耐药率为10.0%(10/100),乙胺丁醇的耐药率为5.0%(5/100),和链霉素的耐药率为40.0%(40/100)。在利福平耐药菌株中,90%(9/10)具有利福平抗性的分离株在RRDR中具有突变(密码子507-533)。在异烟肼耐药菌株中,分别有100%和21%的katG和inhA(包括inhA启动子)发现基因突变;其多药耐药性主要与katG基因中的Ser315Thr突变相关(7/9,77.8%)。59.5%存在耐药性的菌株属于北京谱系,66.7%的MDR菌株属于北京谱系。结论:在TB/HBV合并感染患者的结核分枝杆菌分离株中接近一半(42%)为耐药株,其中以Beijing谱系为主。

标准化治疗方案治疗MDR-TB 26例近期疗效分析

目的评价全球基金结核病项目标准化耐多药肺结核治疗方案对耐多药肺结核(MDR-TB)的疗效。方法观察26例MDR-TB采用标准化耐多药肺结核治疗方案后1个月、6月、12月的痰菌计数、病灶吸收、体重指数变化。结果在治疗后6个月,痰菌计数、病灶吸收、体重指数均较前改善,统计有差异性(P<0.05)。结论全球基金结核病项目标准化耐多药肺结核治疗方案对MDR-TB的近期疗效好,值得进一步临床观察及病例积累。

A pilot study on prevalence and cure rate of tuberculosis in selected areas of Malabar 2006-07.

Objective:To study the prevalence and cure rate of tuberculosis(TB) and the people affected by TB in selected areas,considering different factors like age,sex,percentage of people affected,dosage forms,role of hospitals, and patient category.Methods:A detailed survey was carried out in and around Perinthalmanna and Wayanad(Urban and Rural) to understand the burden and overall trend of TB in our locality and how effective our TB control programme.More than 250 treatment cards were collected from the Government hospitals and TB Sanatorium.Results:In the study,at Perinthalmanna and Wayanad,out of 250 TB patients it was found that males is more susceptible than females,rural area accounting for the greater proportion of TB patients. Greater proportion were affected with pulmonary than extra pulmonary Tuberculosis.The incidence of tuberculosis in different age groups varied according to the area.Half proportion in both rural and urban areas were belonging to categoryⅡfollowed by categoryⅢ.Conclusion:The nature and magnitude of TB is more in rural area than urban area mainly because of the lack of awareness of the severity of disease and improper follow up of preventive measures.Our study suggests that the combined and committed efforts of government,non government organizations,medical and paramedical professional and society is required at large,to reach all patients and ensure that they receive high quality care.

2013—2018年河南省5个耐药监测点结核分枝杆菌耐药性

目的 了解河南省5个耐药监测点结核分枝杆菌的耐药情况,为制定结核病疫情控制策略提供参考。方法 收集2013—2018年河南省5个耐药监测点1 716例结核病患者临床分离株及临床信息,采用比例法测定9种常用抗结核药物敏感性,并分析其耐药特征变化。结果 结核病患者的总耐药率为24.07%(413/1 716),耐多药率为3.73%(64/1 716)。一线抗结核药物耐药率由高到低依次为:链霉素(SM)13.34%(229株)、异烟肼(INH)10.08%(173株)、利福平(RIF)5.19%(89株)、乙胺丁醇(EMB)4.49%(77株);二线抗结核药物耐药率由高到低为:氧氟沙星(OFX)3.15%(54株)、卡那霉素(KAM)2.51%(43株)和卷曲霉素(CPM)2.51%(43株)、对氨基水杨酸(PAS)1.98%(34株)、丙硫异烟胺(PTO)1.46%(25株)。耐药谱结果显示,413株菌分布在68种不同耐药类型中,单耐药中SM、多耐药INH+SM组合、耐多药组合中INH+RIF和INH+RIF+SM组合的耐药率较高。初治患者耐药率和耐多药率分别为20.13%(216/1 073)、2.80%(30/1 073),复治患者耐药率和耐多药率分别为30.64%(197/643)、5.29%(34/643),复治患者耐药率和耐多药率均高于初治患者(均P<0.05)。41~60岁年龄组患者耐药率最高(29.25%),2~20岁年龄组患者耐药率最低(13.56%),各年龄组耐药率比较,差异有统计学意义(P<0.05)。耐药趋势分析结果显示,2013—2018年仅耐多药率呈逐年升高趋势(P<0.05)。结论 河南省5个耐药监测点结核分枝杆菌耐药情况仍然较为严重,耐药谱结果显示耐药类型表现多样化和复杂化,41~60岁年龄组患者耐药率较高,复治患者耐药率较高,耐多药呈上升趋势。因此需要规范治疗,同时开展耐药筛查,减少耐药患者产生,加强耐多药患者的治疗和管理,防止传播。

First Nationwide Survey of the Prevalence of TB/HIV Co-Infection in Ghana

Background: To better understand the extent of the magnitude of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection in Ghana, a baseline study was conducted to establish the national prevalence of the dual infection. The study aimed to determine the most prevalent HIV serotype (HIV-1 or HIV-2) in TB patients (new and old cases);genotype mycobacterial species causing TB/HIV co-infection and determine their drug susceptibility patterns. Methods: Sputum and dried blood samples were collected from 503 TB patients from 67 health facilities nationwide between December 2007 and November 2008. All samples were processed for mycobacterial and HIV testing using conventional and molecular methods. Results: A total of 517 paired sputum samples were received from 517 patients. A total 503 patients [335 (66.6%) males;168 (33.4%) females] had at least one culture positive sample. Majority (93.0%) of the patients were new cases while 7.0% were old cases. All 503 TB isolates were Mycobacterium tuberculosis complex. Of 503 blood samples, 74 were positive for HIV (14.7%), comprising 71 (14.1%) and 3 (0.6%) for HIV-1 and HIV-1 & 2 respectively;none was positive for HIV-2 alone. The seroprevalence of HIV in newly diagnosed TB patients and those already on treatment, was 69/468 (14.7%) and 5/35 (14.3%) respectively (p > 0.05). Differentiation of isolates from TB/HIV co-infected patients showed that 70/74 (94.6%) were Mycobacterium tuberculosis while 4/74 (5.4%) were Mycobacterium africanum. Monoresistance to isoniazid and rifampicin were 4/74 (5.4%) and 1/74 (1.4%) respectively;resistance to both drugs (multi-drug resistant-MDR) was not observed. Sixty nine (93.2%) isolates were susceptible to both drugs. Conclusion: The prevalence of HIV infection in TB patients was 14.7%. TB/HIV was common among the sexually active age group (25 - 34 years). Majority of the TB isolates were M. tuberculosis which were susceptible to both isoniazid and rifampicin. HIV-1 was the common serotype infecting TB patients in Ghana.

耐多药肺结核发生发展的非药物危险因素分析

中国是结核病高发地区,结核病防治形势非常严峻,而耐多药结核(multidrug-resistant tuberculosis,MDR-TB)是结核病防控的重点及难点。为探讨耐多药肺结核发病的危险因素,并构建风险预测模型,本文研究采用病例对照研究,通过现场流行病学调查,探讨耐多药肺结核发病的危险因素;用logistic回归法筛选危险因素,构建风险预测模型;采用受试者的作业特征(received operating characteristic,ROC)曲线下面积来评估其预测效能,拟合优度(hosmer-lemeshow,H-L)检验评价拟合优度。经多因素分析表明,与药敏结核患者相比,男性耐多药患病风险是女性的4.366倍,P=0.002,95%置信区间(confidence interval,CI)1.732~11.004;与高中及以上相比,学历初中及以下的患病风险是13.627倍(P=0.008,95%CI 2.006~92.560);性格内向是保护因素,比值比(odds ratio,OR)=0.181,P=0.033,95%CI 0.037~0.872);每日肉类摄入小于150 g是大于150 g患病风险的3.804倍(P=0.001,95%CI 1.670~8.667)。联合预测因子ROC曲线下面积为0.790(95%CI0.710~0.870)。H-Lχ^(2)检验结果为χ^(2)=14.956,P=0.060。由此可见,男性、初中及以下学历、性格外向、肉类摄入少与耐多药结核病发病相关,联合预测因子模型预测价值较高。

耐多药结核分枝杆菌临床株耐药性分析

目的探讨贵阳市肺科医院住院结核病患者中的耐药情况,为临床诊断和治疗耐多药结核病(MDR-TB)提供可靠的科学依据。方法对2004年1月至2009年8月期间住院患者的临床分离株进行菌型鉴定后,进行药物敏感性试验,分析不同类型结核病患者的耐药情况。结果 2 318株结核分枝杆菌总的耐多药率为23.8%,初始耐多药率为12.1%,获得性耐多药率为63.8%。结论贵阳市肺科医院收治的结核病患者耐药率较高,应尽快加强耐药结核病患者的防治工作,减少和避免MDR-TB患者的产生。

福建省耐多药结核分枝杆菌对氟喹诺酮类药物表型耐药与gyrA基因突变特征分析

目的了解福建省耐多药(Multi-drug resistant,MDR)结核分枝杆菌(Mycobacterium tuberculosis,Mtb)氟喹诺酮类药物(Fluoroquinolones,FQs)的gyrA基因突变特征,为FQs耐药菌株的快速分子药敏检测提供基础科学数据。方法收集来自福建省2010-2011年和2008-2009年耐药监测点的所有MDR Mtb临床菌株,采用常规比例法进行FQs敏感性试验。PCR扩增包含gyrA耐药决定区的基因片段,测序后比对分析。结果共收集到MDR结核分枝杆菌临床菌株119株,经常规药敏试验,氧氟沙星(Ofloxacin,Ofx)的耐药率为26.89%,左氧氟沙星(Levofloxacin,Lfx)耐药率为25.21%,莫西沙星(Moxifloxacin,Mfx)耐药率为11.76%。FQs敏感株gyrA基因未检测到突变。gyrA基因在Ofx耐药菌株的突变率为84.38%(27/32),Lfx耐药菌株的突变率为83.33%(25/30),Mfx耐药菌株的突变率为92.86%(13/14)。gyrA基因突变为点突变,共发现有5种突变类型,以Asp94Gly,Asp94Asn和Ala90Val为主。结论福建省MDR-Mtb对FQs耐药的主要原因是gyrA基因突变,最常见的突变位于第94位,第90位和第91位密码子。

抗结核药物的研究新进展

本文综述了近年抗结核药物的研究进展,分为抗结核药物的历史、现状和未来三部分,重点讲述了一些具有开发前景的喹喏酮类、硝基咪唑类、二芳基喹啉类、吡咯类、噁唑烷酮类、乙二胺类等药物,同时介绍具有开发前景的新型抗结核药物研发新领域,即脂肪酸合酶II抑制剂、移位酶I抑制剂及肽脱甲酰酶抑制剂,其中较有开发前景的抗结核候选药物有PA-824、OPC-67683、TMC207、LL-3858和SQ-109。

西安市结核分枝杆菌耐药基线调查

目的了解西安市肺结核患者的耐药疫情及初始耐药与获得性耐药的耐药情况,为耐药结核病的治疗以及控制模式提供依据。方法将2015年西安市14个区(县)结核病门诊和西安市胸科医院所有初治及复治痰结核分枝杆菌培养阳性的病例作为研究对象,进行4种一线抗结核药物的敏感性试验。结果西安市结核分枝杆菌总耐药率为31.9%,耐多药(MDR)率为7.0%。初治组耐药率为27.3%,MDR率为3.5%。复治组耐药率为59.5%,MDR率为28.6%,复治组耐药率与MDR率均明显高于初治组,差异均有统计学意义(均P<0.001)。结论西安市肺结核患者总耐药率低于全国平均水平,但MDR率略高于全国水平,说明西安市结核病防控工作虽然取得一定成效,但形势依然严峻,特别是要加强初治患者的管理以减少耐药结核病的发生。

噬菌体脂质体包被液治疗小鼠耐多药结核的初步研究

目的:研究D29分枝杆菌噬菌体脂质体包被液对耐多药结核杆菌感染小鼠的治疗效果,探寻治疗耐多药结核病的新方法。方法:用超声波分散法把噬菌体制成脂质体包被液,对小鼠行气管切开法滴入106CFU.mL-1临床耐4药结核分枝菌悬液100μL制备动物模型,以利福平、异烟肼、链霉素、乙胺丁醇(H、R、S、E)联合治疗小鼠组为对照组,对试验组用噬菌体脂质体包被液雾化吸入治疗,剂量为106pfu.d-1。结果:体外实验表明:107pfu.mL-1D29悬液作用1 h达到最佳杀菌效果;小鼠在体实验中,噬菌体脂质体包被液治疗60 d转阴率为75%,治疗120 d转阴率87%;而抗结核病药治疗60 d转阴率为15%,治疗120 d转阴率35%。噬菌体治疗组的平均治愈率显著高于抗结核病药治疗组(81%vs 25%,P<0.05)。结论:噬菌体脂质体包被液对耐药结核菌感染小鼠具有良好的治疗效果,有可能成为治疗耐多药结核病的新方法。

抗痨汤治疗耐多药肺结核的临床疗效观察

目的探讨抗痨汤治疗耐多药肺结核的临床疗效。方法将该院64例耐多药肺结核患者随机分为治疗组和对照组,应用相同化疗方案(6个月阿米卡星,盐酸左氧氟沙星,对氨基水杨酸钠,吡嗪酰胺,丙硫异烟胺/18个月盐酸左氧氟沙星,对氨基水杨酸钠,吡嗪酰胺,丙硫异烟胺),治疗组在该基础上加抗痨汤,对照组在该基础上加中药复方模拟剂,以随机、单盲、安慰剂平行对照,比较两组证候积分、痰菌阴转率、X线吸收率、空洞闭合率、中医证候临床疗效的情况。结果疗程结束,治疗组的证候积分较对照组均明显减少(P<0.01),治疗组痰菌阴转率为78.1%,明显高于对照组的62.5%(χ2=5.497,P<0.05)。治疗组、对照组病灶吸收率分别为81.25%和56.25%,空洞闭合率分别为96.6%和71.4%,中医证候临床疗效分别为100%和81.25%,差异均有统计学意义(P<0.05)。结论治疗组疗效优于对照组,在化疗基础上加用抗痨汤可提高耐多药肺结核的治疗效果,值得临床进一步推广。

2型糖尿病合并初治肺结核患者耐药情况及影响因素分析

目的回顾性分析了2型糖尿病合并初治耐药肺结核患者结核分枝杆菌的耐药情况和影响因素,从而为此类患者的早期发现提供一定的依据。方法收集首都医科大学附属北京胸科医院2012年1月至2014年12月收治的行结核分枝杆菌培养及药敏试验的2型糖尿病合并肺结核患者356例,其中初治耐药患者93例,复治耐药患者56例,初治敏感患者182例。对患者的耐药率、耐药种类、任一耐药率、耐药谱、耐药危险因素等情况进行分析。采用SPSS16.0统计学软件进行统计学分析,P<0.05为差异有显著性意义。结果 356例2型糖尿病合并肺结核患者,总耐药率41.9%,耐多药率达12.9%。2型糖尿病合并初治耐药肺结核患者中,以单耐药和多耐药患者为主,耐单药前三位为耐SM、INH和利福类,喹诺酮类药物的耐药率为11.8%,耐多药患者组合耐药谱以耐HRSEPto+二线注射剂为最多(38.1%)。与初治敏感患者相比,2型糖尿病合并初治耐药肺结核患者体重下降者占多数(P<0.05)。结论 2型糖尿病合并初治肺结核的耐药率较高,以单耐药和多耐药为主,体重下降是2型糖尿病合并初治耐药肺结核患者的影响因素。