华西医学

华西医学

四川大学华西医院 2016 年—2018 年结核分枝杆菌耐药情况分析

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目的了解四川大学华西医院结核分枝杆菌复合群耐药情况,分析其耐药特点,为耐药结核病的监测提供参考。方法采用结核分枝杆菌药物敏感性(药敏)试剂盒对 2016 年 1 月—2018 年 3 月四川大学华西医院实验医学科微生物室结核培养阳性的菌株进行利福平、异烟肼、乙胺丁醇、链霉素 4 种一线抗结核药物和卷曲霉素、氧氟沙星、乙硫异烟胺、对氨基水杨酸、左氧氟沙星、莫西沙星、利福布丁、阿米卡星、卡那霉素、氯苯吩嗪 10 种二线抗结核药物的敏感性试验。结果共纳入患者 130 例(菌株 130 株),其中初治患者 82 例(菌株 82 株),复治患者 48 例(菌株 48 株),结核分枝杆菌复合群总耐药率为 37.69%,初治患者耐药率(28.05%)明显低于复治患者(54.17%),差异有统计学意义(χ2=8.794,P=0.003)。初治患者多重耐药率(6.10%)明显低于复治患者(25.00%),差异均有统计学意义(χ2= 9.517,P=0.002)。初治患者对一线抗结核药物异烟肼、利福平和链霉素的耐药率(23.17%、8.54%、7.32%)明显低于复治患者(45.83%、41.67%、29.17%),差异有统计学意义(P<0.05)。初治患者对二线抗结核药物氧氟沙星、莫西沙星、利福布丁和乙硫异烟胺的耐药率(9.76%、8.54%、7.31%、4.88%)明显低于复治患者(39.58%、27.08%、25.00%、22.92%),差异有统计学意义(P<0.05)。结论应加强结核初治患者的规范化治疗,加大对复治结核患者的治疗和管理,预防耐药患者尤其是耐多药患者的产生和传播。

ObjectiveTo understand the drug resistance of Mycobacterium tuberculosis complex in West China Hospital, Sichuan University, analyze its drug resistance characteristics, and provide reference for the monitoring of drug-resistant tuberculosis.MethodsFrom January 2016 to March 2018, Mycobacterium tuberculosis drug susceptibility testing kit was used to detect the drug susceptibility of Mycobacterium tuberculosis culture-positive strains in Department of Laboratory Medicine, West China Hospital, Sichuan University. The tested drugs included four of the first-line anti-tuberculosis drugs: rifampicin, isoniazid, ethambutol, and streptomycin, and ten of the second-line anti-tuberculosis drugs: capreomycin, ofloxacin, ethionamide, p-aminosalicylic acid, levofloxacin, moxifloxacin, rifabutin, amikacin, kanamycin, and chlorine phenazine.ResultsA total of 130 patients (130 strains) were enrolled, including 82 newly diagnosed patients (82 strains) and 48 re-treated patients (42 strains). The drug resistance rate of the 130 patients was 37.69%. The drug resistance rate of the newly diagnosed patients (28.05%) was significantly lower than that of the re-treated patients (54.17%), and there was a statistical difference (χ2=8.794, P=0.003). The multi-drug resistance rate of the newly diagnosed patients (6.10%) was significantly lower than that of the re-treated patients (25.00%), and the difference was statistically significant (χ2=9.517, P=0.002). The resistance rate of isoniazid, rifampicin, and streptomycin in newly diagnosed patients (23.17%, 8.54%, and 7.32%, respectively) were significantly lower than those in the re-treated patients (45.83%, 41.67%, and 29.17%, respectively), and the differences were statistically significant (P<0.05). The resistance rate of ofloxacin, moxifloxacin, rifabutin and ethionamide in the newly diagnosed patients (9.76%, 8.54%, 7.31%, and 4.88%, respectively) were significantly lower than those in the re-treated patients (39.58%, 27.08%, 25.00%, and 22.92%, respectively), and the differences were statistically significant (P<0.05).ConclusionIt is necessary to strengthen the standardized treatment of patients with newly diagnosed tuberculosis, increase the treatment and management of re-treated tuberculosis patients, and prevent the generation and spread of drug-resistant patients, especially multidrug-resistant patients.

关键词: 结核分枝杆菌; 药物敏感性试验; 耐药率

Key words: Mycobacterium tuberculosis; Drug susceptibility testing; Drug resistance rate

引用本文: 戴仲秋, 张雨薇, 邓劲, 陈知行, 吴思颖, 刘雅, 邓杰伦, 谢轶. 四川大学华西医院 2016 年—2018 年结核分枝杆菌耐药情况分析. 华西医学, 2018, 33(8): 984-988. doi: 10.7507/1002-0179.201807044 复制

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