440株结核分枝杆菌耐药情况及影响因素分析
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摘要
目的:了解结核分枝杆菌(M.tb)的耐药情况,为制定耐药结核病防治策略提供参考。方法:收集M.tb培养结果为阳性且具有药敏试验结果的病例477例,分析M.tb分离株对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、对氨基水杨酸(PAS)、丙硫异烟胺(PTO)、左氧氟沙星(LFX)、阿米卡星(AK)8种抗结核药物的敏感性及耐药影响因素。结果:440例标本类型为痰液,培养结果为人型结核分枝杆菌病例。总耐药率为52.5%,其中初治患者耐药率42.5%,复治患者耐药率86.1%,复治患者的耐药率明显高于初治患者(P<0.05)。4种一线抗结核药物中SM(40.5%)耐药率最高;4种二线抗结核药物中LFX(13.0%)耐药率最高。初治患者的单耐药率明显高于复治患者(P<0.05),而复治患者的耐多药率显著高于初治患者(P<0.05),初、复治患者的多耐药率无明显统计学差异(P<0.05)。初治患者有3种单耐药类型,10种多耐药类型,15种耐多药类型;复治患者1种单耐药类型,8种多耐药类型,24种耐多药类型。有无治疗史对结核病患者耐药率的影响经比较其差异有统计学意义。结论:应加强抗结核药物的耐药性监测及对结核病患者的治疗管理,根据药敏结果选择个体化的治疗方案。
Objective:To understand the prevalence of drug-resistance tuberculosis in Peace Hospital,so as to provide reference for formulating prevention and control strategies of drug resistance tuberculosis in Changzhi.Methods:During the period from January 2012 to June 2017 in our hospital,clinical data of patients with positive Mycobacterium tuberculosis(M.tb)culture results and drug susceptibility test results were collected.And the drug resistance and influencing factors of M.tbisolates were analyzed for 8 isoniazid,rifampicin,ethambutol,streptomycin,pamisyl,protionamide,levofloxacin,amikacin anti-tuberculosis drug.Results:A total of 440 cases that the specimen was sputum and the culture result was human Mycobacterium tuberculosis were collected.By analysis,the total drug resistant rate was 52.5%.The initial treatment patients with drug resistant rate was 42.5%and retreatment patients drug resistant rate was 86.1%.Therefore,the resistant rate of retreatment patients was significantly higher than those of untreated patients.Streptomycin resistant(40.5%)was the highest in the 4 first-line anti-tuberculosis drugs and levofloxacin resistant(13.0%)was the highest in the 4 second-line anti-tuberculosis drugs.The initial patients with significantly higher mono-drug resistant rate than retreatment patients(P=0.010),retreatment patients with significantly higher multi-drug resistant rate than those of untreated patients(P<0.001),but the difference of initial treatment and retreatment patients with poly-drug resistant rate was not statistically significant(P=0.772).Initial treatment patients showed 3 type of mono-drug resistance,10 type of poly-drug resistance,15 type of multi-drug resistance;While retreatment patients showed 1 type of mono-drug resistance,8 type of poly-drug resistance,24 type of multi-drug resistance.The effect of the history of anti-tuberculosis treatment on the drug resistant rate of tuberculosis patients was statistically significant.Conclusion:The drug resistance of mycobacterium tuberculosis is very serious in our hospital.The monitoring of anti-tuberculosis drug resistance and the treatment management of tuberculosis patients should be strengened,so as to optimize individualized chemotherapy based on the results of drug sensitivity.
Objective:To understand the prevalence of drug-resistance tuberculosis in Peace Hospital,so as to provide reference for formulating prevention and control strategies of drug resistance tuberculosis in Changzhi.Methods:During the period from January 2012 to June 2017 in our hospital,clinical data of patients with positive Mycobacterium tuberculosis(M.tb)culture results and drug susceptibility test results were collected.And the drug resistance and influencing factors of M.tbisolates were analyzed for 8 isoniazid,rifampicin,ethambutol,streptomycin,pamisyl,protionamide,levofloxacin,amikacin anti-tuberculosis drug.Results:A total of 440 cases that the specimen was sputum and the culture result was human Mycobacterium tuberculosis were collected.By analysis,the total drug resistant rate was 52.5%.The initial treatment patients with drug resistant rate was 42.5%and retreatment patients drug resistant rate was 86.1%.Therefore,the resistant rate of retreatment patients was significantly higher than those of untreated patients.Streptomycin resistant(40.5%)was the highest in the 4 first-line anti-tuberculosis drugs and levofloxacin resistant(13.0%)was the highest in the 4 second-line anti-tuberculosis drugs.The initial patients with significantly higher mono-drug resistant rate than retreatment patients(P=0.010),retreatment patients with significantly higher multi-drug resistant rate than those of untreated patients(P<0.001),but the difference of initial treatment and retreatment patients with poly-drug resistant rate was not statistically significant(P=0.772).Initial treatment patients showed 3 type of mono-drug resistance,10 type of poly-drug resistance,15 type of multi-drug resistance;While retreatment patients showed 1 type of mono-drug resistance,8 type of poly-drug resistance,24 type of multi-drug resistance.The effect of the history of anti-tuberculosis treatment on the drug resistant rate of tuberculosis patients was statistically significant.Conclusion:The drug resistance of mycobacterium tuberculosis is very serious in our hospital.The monitoring of anti-tuberculosis drug resistance and the treatment management of tuberculosis patients should be strengened,so as to optimize individualized chemotherapy based on the results of drug sensitivity.
引文
[1]World Health Organizaition.Global Tuberculosis Report2017[R].World Health Organizaition,2017.
[2]陆伟,周扬,陈诚,等.江苏省社区人群结核杆菌耐药状况及影响因素研究[J].中华疾病控制杂志,2013,17(7):560-563.
[3]李香社,祝玉芬.我国结核分枝杆菌耐药现状及研究进展[J].临床误诊误治,2017,30(7):114-116.
[4]中华人民共和国卫生部疾病预防控制局,中华人民共和国卫生部医政司,中国疾病预防控制中心.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009:57.
[5]中国防痨协会.耐药结核病化学治疗指南(2015)[J].中国防痨杂志,2015,37(5):421-469.
[6]车洋,杨天池,于梅,等.116例耐多药结核分枝杆菌临床分离株对4种注射用抗结核药物耐药及交叉耐药分析[J].中国卫生检验杂志,2016,26(12):1802-1804.
[7]邓建平,王斌,张正东,等.自贡市肺结核分枝杆菌对一线抗结核药物耐药性分析[J].中国预防医学杂志,2016,17(10):759-761.
[8]潘建华,罗丹,石国民,等.2012—2015年长沙地区肺结核患者结核分枝杆菌耐药状况分析[J].现代预防医学,2016,43(8):1499-1501,1516.
[9]高华强,金法祥,卢巧玲,等.2010—2014年浙江省绍兴市涂阳肺结核患者耐药特征分析[J].疾病监测,2016,31(7):609-613.
[10]王赟,石小俊,张幼萍,等.114株结核分枝杆菌耐药性分析[J].预防医学,2016,28(11):1131-1132,1135.
[11]田飞,王宏勇,王亚西,等.铜仁市结核病耐药监测结果分析[J].中国卫生检验杂志,2016,26(6):855-857,862.
[12]夏岚,张佩如,饶正远,等.四川省6 158例涂阳肺结核患者耐药检测结果分析[J].疾病监测,2016,31(8):692-696.
[13]中华人民共和国卫生部.全国结核病耐药性基线调查报告(2007—2008年)[R].北京:人民卫生出版社,2010:3.
[2]陆伟,周扬,陈诚,等.江苏省社区人群结核杆菌耐药状况及影响因素研究[J].中华疾病控制杂志,2013,17(7):560-563.
[3]李香社,祝玉芬.我国结核分枝杆菌耐药现状及研究进展[J].临床误诊误治,2017,30(7):114-116.
[4]中华人民共和国卫生部疾病预防控制局,中华人民共和国卫生部医政司,中国疾病预防控制中心.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009:57.
[5]中国防痨协会.耐药结核病化学治疗指南(2015)[J].中国防痨杂志,2015,37(5):421-469.
[6]车洋,杨天池,于梅,等.116例耐多药结核分枝杆菌临床分离株对4种注射用抗结核药物耐药及交叉耐药分析[J].中国卫生检验杂志,2016,26(12):1802-1804.
[7]邓建平,王斌,张正东,等.自贡市肺结核分枝杆菌对一线抗结核药物耐药性分析[J].中国预防医学杂志,2016,17(10):759-761.
[8]潘建华,罗丹,石国民,等.2012—2015年长沙地区肺结核患者结核分枝杆菌耐药状况分析[J].现代预防医学,2016,43(8):1499-1501,1516.
[9]高华强,金法祥,卢巧玲,等.2010—2014年浙江省绍兴市涂阳肺结核患者耐药特征分析[J].疾病监测,2016,31(7):609-613.
[10]王赟,石小俊,张幼萍,等.114株结核分枝杆菌耐药性分析[J].预防医学,2016,28(11):1131-1132,1135.
[11]田飞,王宏勇,王亚西,等.铜仁市结核病耐药监测结果分析[J].中国卫生检验杂志,2016,26(6):855-857,862.
[12]夏岚,张佩如,饶正远,等.四川省6 158例涂阳肺结核患者耐药检测结果分析[J].疾病监测,2016,31(8):692-696.
[13]中华人民共和国卫生部.全国结核病耐药性基线调查报告(2007—2008年)[R].北京:人民卫生出版社,2010:3.