新疆喀什地区肺结核耐药状况及影响因素分析
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摘要
目的：了解新疆喀什地区结核分支杆菌耐药现状、探讨耐药的影响因素,为更好的制定耐药结核病控制及预防策略提供理论依据。方法：收集2010年6月-2010年12月在喀什胸科医院住院诊治的全部新发及复治痰结核分支杆菌涂片阳性的肺结核患者的痰标本,用改良酸性罗氏培养基培养,按绝对浓度法对结核菌株经PNB、TCH鉴别分型136株结核分枝杆菌作为药物敏感试验对象；应用比例法对全部培养阳性标本进行8种抗结核药物(异烟肼,利福平,链霉素,乙胺丁醇,氧氟沙星,卷曲霉素,卡那霉素,阿米卡星)的耐药性检测,回顾性收集患者临床资料。结果：136株结核分离株可用,109例(80.15%)为人结核分枝杆菌,26例(19.12%)为牛结核分支杆菌,1例(0.74%)为非结核分枝杆菌。研究对象中有56例来自初治肺结核患者,80例来自复治肺结核患者,患者总耐药率为32.35%,初始耐药率28.57%,获得性耐药率为35.00%,总耐多药率为6.62%,初始耐多药率为3.57％,获得性耐多药率8.75%,无广泛耐药发生。8种耐任一抗结核药物的耐药率由高到低分别为H(22.79%).S(11.76%).R(8.82%).E(6.62％).Ofx(2.94％).Cm(2.94％).Km(0.74％).Am(0.74%)。初治结核病人对异烟肼、链霉素、利福平、乙胺丁醇、氧氟沙星、卷曲霉素、卡那霉素、阿米卡星这8种抗结核药物的耐药率分别为：17.86%、16.07%、3.57%、5.36%、3.57%、0%、0%、0%；复制患者对以上8种抗结核药物的耐药率分别为:26.25％.8.75％.12.50％.7.50％.2.50％.1.25％.1.25％.耐1种.2种.3种和4种以上一线药物的初始耐药率和获得性耐药率分别为17.86%、3.57%、5.36%、0%和15.00%、13.75%,3.75%、0%,初治及复治患者的耐2药率差异有统计学意义。不同年龄组耐药率差异无显著性；不同性别、年龄组初始耐药差异无显著性。经单因素非条件logistic回归分析,不同性别、不同文化程度、不同居住地、不同职业、有无慢性病史、有无空洞、化疗史、有无延误对耐药率的影响差异无统计学意义(P>0.05)。结论：患结核杆菌的以人型结核杆菌最为常见。新疆喀什地区耐药结核病的发生率较高,耐药现状引起重视。本次研究表明8种抗结核药物均有一定程度的耐药,抗结核药物中耐药率排序前三位的分别是异烟肼、链霉素、利福平。性别、年龄对初治耐药率无影响。常规结核分支杆菌培养及药敏试验可以科学合理的指导临床用药,对于控制结核病的传播有极其重要的流行病学意义。
Objective:study the status of the drug resistence of mycobacterium tuberculosis, discuss factor influencing drug resistence to mycobacterium tuberculosis in the city of kashi, xinjiang province, and provide theoretical evidence for tuberculosis control and prevent strategy in the future. Methods:136 sputum specimens of smear positive, were collect from all in-patient cases of tuberculosis from June to December 2010 in KaShi Chest Hospital, Ameliorative Lowenstein-Jensen culture medium was used to detect bacillus, positive specimen o f pulmonary tuberculosis by typing using PNB and TCH. To tally 136 samples were confirmed to be positive by culturing. Drug susceptibility test against streptomycin(INH, SM, RFP, EB, OFX, Km, Amk, Cm), was conducted by the proportion method, and collect the chinical data by retrospective method.Results:Among 136 sputum specimens containing Mycobacterium tuberculosis,109 strains (8015%)were identified to human pulmonary tuberculosis; 26 strains (19.12%) were identified to bovine pulmonary tuberculosis; strain(0.74%) non-tuberculosis mycobacteria.56 were from patients of primary tuberculosis, while 80 from patients of recurrent tuberculosis.the rate of total drug resistance was32.35%, the rate of initial drug resistance was28.57%, the rate of acquired drug resistance was35.00%, the rate of total multidrug resistance was6.62%, the rate of initial drug multidrug resistance was3.57%, and the rate of acquired drug multidrug resistance was8.75%, and no XDR-TB was found in this study. Any resistancetoINH, SM, RFP, EMB, OFX, Cm, Km, Amkwas22.79%,11.76%,8.82%, 6.62%,2.94%,2.94%,0.74%,0.74%, Respectively. In the former group, the rate of drug resistance to eight anti-tuberculosis medications including INH, SM, FPR, EB, OFX, CPM, K and AK was 17.86%,16.07%,3.57%,5.36%,3.57%,0%,0%,0%; in the latter group, the rate of resistance to eight anti-tuberculosis drug was 26.25%,8.75%,12.50%, 7.50%,2.50%,1.25%,1.25%. The resistant rates to 1,2,3 and 4 or more drugs were 17.86%,3.57%,5.36%and0% in new cases and 5.00%,13.75%,3.75% and 0% in previously treated cases, comparing patients from primary versus recurrent evaluated by X2 test, there was a statistically significant difference in the resistant rates to 2. The total drug resistant rate did not show significant difference (P>0.05) among different age groups; The initial drug resistant rate did not show significant difference (P>0.05) among different sex and age groups. Single non-conditional logistic regression analysis showed that The differences of gender、culture level、live address、occupation、chronic disease、cavity、the history of previous treatment、delaye were not significantly correlated with drug resistance(P>0.05). Conclusion:To study, The rate of man-Mycobacterium tuberculosis was higher than that to other Bacteriums. The incidence of TB drug resistance is high and merit s at tention in the city of KaShi in Xin Jiang province. The problem of drug resistance was noted in 8 anti-tuberculosis medications to various degrees.This study demonstrated that the top three highly-resisted drug were isoniazid,streptomycin and rifampin.The initial drug resistant rate did not show influence among different sex and age groups. Routine Mycobacterium tuberculosis culture and drug susceptibility test were helpful in selecting anti-tuberculosis drug in a scientific,reasonable and effective manner.such tests also had epidemiological significance for controlling spread of tuberculosis.
Objective:study the status of the drug resistence of mycobacterium tuberculosis, discuss factor influencing drug resistence to mycobacterium tuberculosis in the city of kashi, xinjiang province, and provide theoretical evidence for tuberculosis control and prevent strategy in the future. Methods:136 sputum specimens of smear positive, were collect from all in-patient cases of tuberculosis from June to December 2010 in KaShi Chest Hospital, Ameliorative Lowenstein-Jensen culture medium was used to detect bacillus, positive specimen o f pulmonary tuberculosis by typing using PNB and TCH. To tally 136 samples were confirmed to be positive by culturing. Drug susceptibility test against streptomycin(INH, SM, RFP, EB, OFX, Km, Amk, Cm), was conducted by the proportion method, and collect the chinical data by retrospective method.Results:Among 136 sputum specimens containing Mycobacterium tuberculosis,109 strains (8015%)were identified to human pulmonary tuberculosis; 26 strains (19.12%) were identified to bovine pulmonary tuberculosis; strain(0.74%) non-tuberculosis mycobacteria.56 were from patients of primary tuberculosis, while 80 from patients of recurrent tuberculosis.the rate of total drug resistance was32.35%, the rate of initial drug resistance was28.57%, the rate of acquired drug resistance was35.00%, the rate of total multidrug resistance was6.62%, the rate of initial drug multidrug resistance was3.57%, and the rate of acquired drug multidrug resistance was8.75%, and no XDR-TB was found in this study. Any resistancetoINH, SM, RFP, EMB, OFX, Cm, Km, Amkwas22.79%,11.76%,8.82%, 6.62%,2.94%,2.94%,0.74%,0.74%, Respectively. In the former group, the rate of drug resistance to eight anti-tuberculosis medications including INH, SM, FPR, EB, OFX, CPM, K and AK was 17.86%,16.07%,3.57%,5.36%,3.57%,0%,0%,0%; in the latter group, the rate of resistance to eight anti-tuberculosis drug was 26.25%,8.75%,12.50%, 7.50%,2.50%,1.25%,1.25%. The resistant rates to 1,2,3 and 4 or more drugs were 17.86%,3.57%,5.36%and0% in new cases and 5.00%,13.75%,3.75% and 0% in previously treated cases, comparing patients from primary versus recurrent evaluated by X2 test, there was a statistically significant difference in the resistant rates to 2. The total drug resistant rate did not show significant difference (P>0.05) among different age groups; The initial drug resistant rate did not show significant difference (P>0.05) among different sex and age groups. Single non-conditional logistic regression analysis showed that The differences of gender、culture level、live address、occupation、chronic disease、cavity、the history of previous treatment、delaye were not significantly correlated with drug resistance(P>0.05). Conclusion:To study, The rate of man-Mycobacterium tuberculosis was higher than that to other Bacteriums. The incidence of TB drug resistance is high and merit s at tention in the city of KaShi in Xin Jiang province. The problem of drug resistance was noted in 8 anti-tuberculosis medications to various degrees.This study demonstrated that the top three highly-resisted drug were isoniazid,streptomycin and rifampin.The initial drug resistant rate did not show influence among different sex and age groups. Routine Mycobacterium tuberculosis culture and drug susceptibility test were helpful in selecting anti-tuberculosis drug in a scientific,reasonable and effective manner.such tests also had epidemiological significance for controlling spread of tuberculosis.
引文
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