秦皇岛市结核病患者一线抗结核药物的耐药性调查
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摘要
目的通过分析4年间结核病患者对4种一线抗结核药物的总体耐药情况,了解结核病的耐药特点及趋势,为结核病防治工作提供参考。方法收集2014年1月-2017年12月期间结核病患者送检的各类标本中分离出的结核分枝杆菌共849株,均采用比例法对链霉素(Streptomycin,S)、异烟肼(Isoniazid,H)、利福平(Rifampin,R)、乙胺丁醇(Ethambutol,E) 4种一线抗结核药物进行药物敏感试验,SPSS统计软件进行数据分析,分析各年间的耐药变化趋势。结果自2014-2017年共分离出849株结核分枝杆菌,对一线抗结核药物的耐药率在2014年、2015年、2016年和2017年4年分别为50. 2%(102/203),40. 1%(59/147),37. 2%(61/164)和29%(97/335); 4年的总耐药率,总耐多药率、总单耐药率、总多耐药率分别为37. 6%(319/849)、9. 2%(78/849)、19. 2%(163/849)和9. 2%(78/849)。4年的利福平、异烟肼总耐药率分别为13. 1%(111/849),17. 3%(147/849); 4种一线药物4年的总耐药率由高到低的排序分别为链霉素23. 8%(202/849),异烟肼17. 3%(147/849),乙胺丁醇14. 5%(123/849),利福平13. 1%(111/849)。2014～2017年度一线抗结核药物的单耐药、多耐药和利福平耐药呈逐年递降趋势,其中H多耐药的逐年增加趋势具有统计学意义(P <0. 05)。链霉素和异烟肼的原发单耐药率高于继发单耐药率(P <0. 05);原发R多耐药率高于继发R多耐药(P <0. 05)。原发耐多药率(Multidrug-resistant tuberculosis,MDR-TB)低于继发MDR的耐药率(P<0. 05)。结论 H单耐药和H多耐药呈年度增加趋势,但仅H多耐药的差异具有统计学意义(P <0. 05)应引起我们足够的重视,因为H也是抗结核的最关键药物之一。
Objective To investigate the resistance to 4 kinds of first-line anti tuberculosis drugs in 4 years,and to observe the characteristics and trends of the drug resistance of tuberculosis so as to provide the reference for the prevention and control of tuberculosis. Methods A total of 849 Mycobacterium tuberculosis strains isolated from tuberculosis patients from January 2014 to December 2017 were collected,the drug susceptibility testing for four kinds of first-line anti-TB drugs,including streptomycin,isoniazid,rifampicin and ethambuto,was performed by using proportion method,and the data analysis with SPSS and the change rules and change tend of drug resistance in different years were observed. Results A total of 849 strains of Mycobacterium tuberculosis were isolated from 2014 to 2017,and the resistance rate to first-line anti-tuberculosis drugs was 50. 2%( 102/203),40. 1%( 59/147),37. 2%( 61/164),and 29%( 97/335),respectively. In the past 4 years,the total drug resistance rate,total multi-drug resistance( MDR) rate,total single drug resistance( SDR) rate,and poly-resistant( PDR) rate was 37. 6%( 319/849),9. 2%( 78/849),19. 2%( 163/849),and 9. 2%( 78/849),respectively. In the past 4 years,the total drug resistance rate of rifampicin and isoniazid was 13. 1%( 111/849) and 17. 3%( 147/849),respectively. In the four years,the highest resistance rate of the four first-line drugs were as follows: streptomycin 23. 8%( 202/849),isoniazid 17. 3%( 147/849),ethambutol 14. 5%( 123/849),and rifampicin 13. 1%( 111/849). The single-drug resistance,multi-drug resistance and rifampicin resistance of first-line anti-tuberculosis drugs from 2014 to 2017 showed a downward trend year by year. Among them,the increasing trend of H-resistance was statistically significant( P <0. 05). The primary single drug resistance rate of streptomycin and isoniazid was higher than that of secondary single drug resistance( P < 0. 05). The primary R multi-drug resistance rate was higher than that of secondary R( P <0. 05). The multi-drug resistant tuberculosis( MDR-TB) was lower than that of the secondary MDR( P < 0. 05).Conclusion The H single-drug resistance and multi-drug resistance show an increasing trend,but only the difference in H multi-drug resistance is statistically significant( P < 0. 05). We should pay enough attention because H is also the most important anti-tuberculosis drug.
Objective To investigate the resistance to 4 kinds of first-line anti tuberculosis drugs in 4 years,and to observe the characteristics and trends of the drug resistance of tuberculosis so as to provide the reference for the prevention and control of tuberculosis. Methods A total of 849 Mycobacterium tuberculosis strains isolated from tuberculosis patients from January 2014 to December 2017 were collected,the drug susceptibility testing for four kinds of first-line anti-TB drugs,including streptomycin,isoniazid,rifampicin and ethambuto,was performed by using proportion method,and the data analysis with SPSS and the change rules and change tend of drug resistance in different years were observed. Results A total of 849 strains of Mycobacterium tuberculosis were isolated from 2014 to 2017,and the resistance rate to first-line anti-tuberculosis drugs was 50. 2%( 102/203),40. 1%( 59/147),37. 2%( 61/164),and 29%( 97/335),respectively. In the past 4 years,the total drug resistance rate,total multi-drug resistance( MDR) rate,total single drug resistance( SDR) rate,and poly-resistant( PDR) rate was 37. 6%( 319/849),9. 2%( 78/849),19. 2%( 163/849),and 9. 2%( 78/849),respectively. In the past 4 years,the total drug resistance rate of rifampicin and isoniazid was 13. 1%( 111/849) and 17. 3%( 147/849),respectively. In the four years,the highest resistance rate of the four first-line drugs were as follows: streptomycin 23. 8%( 202/849),isoniazid 17. 3%( 147/849),ethambutol 14. 5%( 123/849),and rifampicin 13. 1%( 111/849). The single-drug resistance,multi-drug resistance and rifampicin resistance of first-line anti-tuberculosis drugs from 2014 to 2017 showed a downward trend year by year. Among them,the increasing trend of H-resistance was statistically significant( P <0. 05). The primary single drug resistance rate of streptomycin and isoniazid was higher than that of secondary single drug resistance( P < 0. 05). The primary R multi-drug resistance rate was higher than that of secondary R( P <0. 05). The multi-drug resistant tuberculosis( MDR-TB) was lower than that of the secondary MDR( P < 0. 05).Conclusion The H single-drug resistance and multi-drug resistance show an increasing trend,but only the difference in H multi-drug resistance is statistically significant( P < 0. 05). We should pay enough attention because H is also the most important anti-tuberculosis drug.
引文
[1]孙付胜,吴慧娜,谷洪梅,等.耐药结核病防治研究进展[J].医学综述,2018,24(1):86-89,94.
[2]张丽霞,王静宜,吴敏,等.天津市一线抗结核药物的耐药变迁与临床督导机制的研究[J].中华医院感染学杂志,2015,25(2):336-338.
[3] World Health Organization. Guidelines for the Surveillance of Drug Resistance in Tuberculosis[S]. 5th edition. Geneva:World Health Organization,2015:13-19.
[4]柳正卫,何海波,缪梓萍,等. 984株结核分枝杆菌耐药情况分析[J].中国防痨杂志,2007,29(2):167-170.
[5]黄麦玲,高孟秋. WHO 2014年版《耐药结核病规划管理指南伙伴手册》系列解读之八(单耐药和多耐药结核病的治疗管理)[J].中国防痨杂志,2015,37(7):802-804.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]李雨晴,万李,陈杏,等.中国西北四省(区)结核分枝杆菌分离株一线药物耐药状况及其影响因素分析[J].中国人兽共患病学报,2017,33(5):398-402,422.
[8]程曦,李亚斐,饶英,等. 2271例结核病患者耐药情况的流行病学特征分析[J].重庆医学,2015,44(12):1635-1637.
[9]郭晶,林霏申,张向荣,等.南京地区2013-2014年结核分枝杆菌耐药流行情况调查[J].临床肺科杂志,2016,21(6):1076-1079.
[10]李君,单志力,朱小梅,等.结核分枝杆菌对一线抗结核药物的耐药性分析[J].中华医院感染学杂志,2018,28(13):1925-1928.
[11]钟球,尹建军,钱明,等.广东省结核病耐药性基线调查研究[J].中国防痨杂志,2011,33(7):393-399.
[12]金凤霞,金瑶,黄庆萍.初治菌阳肺结核患者异烟肼和利福平原发耐药调查[J].临床肺科杂志,2017,22(5):792-794.
[13]宋育明,杨色娟. 997例结核分枝杆菌的耐药性分析[J].中国微生态学杂志,2016,28(3):333-336.
[14]庞力娟,肖红卫,周晋,等. 2010-2015年株洲市结核分枝杆菌一线抗结核药物耐药研究[J].实用预防医学,2017,24(5):582-585.
[2]张丽霞,王静宜,吴敏,等.天津市一线抗结核药物的耐药变迁与临床督导机制的研究[J].中华医院感染学杂志,2015,25(2):336-338.
[3] World Health Organization. Guidelines for the Surveillance of Drug Resistance in Tuberculosis[S]. 5th edition. Geneva:World Health Organization,2015:13-19.
[4]柳正卫,何海波,缪梓萍,等. 984株结核分枝杆菌耐药情况分析[J].中国防痨杂志,2007,29(2):167-170.
[5]黄麦玲,高孟秋. WHO 2014年版《耐药结核病规划管理指南伙伴手册》系列解读之八(单耐药和多耐药结核病的治疗管理)[J].中国防痨杂志,2015,37(7):802-804.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]李雨晴,万李,陈杏,等.中国西北四省(区)结核分枝杆菌分离株一线药物耐药状况及其影响因素分析[J].中国人兽共患病学报,2017,33(5):398-402,422.
[8]程曦,李亚斐,饶英,等. 2271例结核病患者耐药情况的流行病学特征分析[J].重庆医学,2015,44(12):1635-1637.
[9]郭晶,林霏申,张向荣,等.南京地区2013-2014年结核分枝杆菌耐药流行情况调查[J].临床肺科杂志,2016,21(6):1076-1079.
[10]李君,单志力,朱小梅,等.结核分枝杆菌对一线抗结核药物的耐药性分析[J].中华医院感染学杂志,2018,28(13):1925-1928.
[11]钟球,尹建军,钱明,等.广东省结核病耐药性基线调查研究[J].中国防痨杂志,2011,33(7):393-399.
[12]金凤霞,金瑶,黄庆萍.初治菌阳肺结核患者异烟肼和利福平原发耐药调查[J].临床肺科杂志,2017,22(5):792-794.
[13]宋育明,杨色娟. 997例结核分枝杆菌的耐药性分析[J].中国微生态学杂志,2016,28(3):333-336.
[14]庞力娟,肖红卫,周晋,等. 2010-2015年株洲市结核分枝杆菌一线抗结核药物耐药研究[J].实用预防医学,2017,24(5):582-585.