浙江省温州地区196株分枝杆菌耐药监测情况

发布时间：2018-03-22 20:30

本文选题：结核分枝杆菌　切入点：抗药性　出处：《疾病监测》2016年12期 　论文类型：期刊论文

【摘要】：目的了解浙江省温州市分枝杆菌耐药状况,为制定耐药结核病控制策略提供依据。方法随机抽取温州市3县(市)作为耐药监测点,选取监测点2008年和2013年新发和复治涂阳肺结核患者分枝杆菌分离株196株进行4种一线抗结核药物[异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)]的耐药性测定;对耐多药(MDR)菌株进行9种二线抗结核药物[卡那霉素(KM)、阿米卡星(AM)、卷曲霉素(CPM)、对氨基水杨酸(PAS)、丙硫异烟胺(PTO)、环丝氨酸(CS)、氧氟沙星(Of X)、左氧氟沙星(LVFX)、莫西沙星(MOX)]的耐药性测定。结果在196株分枝杆菌中,结核分枝杆菌191株。总耐药率为25.1%(48/191),其中新涂阳和复治涂阳耐药率分别为21.9%(36/164)和44.4%(12/27),差异有统计学意义(χ2=6.23,P0.05);MDR率为6.8%(13/191),其中新涂阳和复治涂阳MDR率分别为4.3%(7/164)和22.2%(6/27),差异有统计学意义(χ2=9.12,P0.01);4种一线抗结核药物的耐药率由高到低依次为S(19.9%)、H(14.7%)、R(7.9%)、E(3.1%);耐1、2、3和4种药物的耐药率分别为14.7%、5.2%、2.6%和2.6%;男性与女性的耐药率和MDR率分别为25.5%(36/141)、6.4%(9/141)和24.0%(12/50)、8.0%(4/50),差异无统计学意义(χ2分别为0.05和0.93,均P0.05);不同年龄组间耐药率差异无统计学意义(χ2=5.34,P0.05);MDR菌株二线抗结核药物耐药率达8/13;二线抗结核药物的耐药率由高到低依次为OFX和PAS(均为5/13)、CS(4/13)、LVFX和MOX(均为1/4)、CPM(1/13)。结论温州市耐多药结核病疫情较严重,而且对二线抗结核药物具有较高的耐药率,建议开展二线抗结核药物敏感性检测,加强耐药结核病患者的发现和治疗管理工作。
[Abstract]:Objective to understand the drug resistance status of Mycobacterium tuberculosis in Wenzhou, Zhejiang Province, and to provide the basis for the formulation of drug resistant tuberculosis control strategy. Methods three counties (cities) of Wenzhou were randomly selected as drug resistance monitoring points. The drug resistance of four first-line anti-tuberculosis drugs (isoniazid, rifampicin, streptomycin Schiff, ethambutanol E) were determined in the surveillance sites in 2008 and 2013, and 196 strains of Mycobacterium tuberculosis were isolated from newly developed and re-treated smear positive pulmonary tuberculosis patients in 2008 and 2013. Nine second-line anti-tuberculosis drugs (kanamycin, amikacin, capramycin, pASA, PTOU, CSN, ofloxacin of Of XX, levofloxacin, moxifloxacin, moxifloxacin) were applied to the multidrug resistant MDR strain. Determination of drug resistance. Results among 196 strains of Mycobacterium, 191 strains of Mycobacterium tuberculosis. The total drug resistance rate of Mycobacterium tuberculosis is 25.1g / 48 / 191g, of which the rates of new smear positive and retreated smear positive resistance are 21.936 / 164) and 44.44.43% / 12 / 27, respectively. The difference is statistically significant (蠂 ~ 2 ~ (6.23. 23) P _ (0.05) P ~ (0.05) P = 6.813 / 191 ~ (-1), in which the MDR rates of new smear positive and retreated smear positive are 4.377% 164) and 22.22o 6 / 27, respectively. The difference is statistically significant. Significance (蠂 2 9.12 P0.01A 4 anti-tuberculosis drug resistance rates from high to low: S19.9C, P = 14.77.9C, P = 2.75.22.6% and 2.6%, respectively, respectively) and 24.01250% (蠂 2 = 8.050%), with no significant difference (蠂 2 = 8.050%, P = 4.05%, P < 0.05), respectively (蠂 ~ 2 = 2.65%, P < 0.01), and 24.01250% (蠂 ~ 2 = 8.00%), no significant difference (蠂 ~ 2 = 8.05%, P < 0.05), respectively (蠂 ~ 2 = 8.05%, P < 0.05). The drug resistance rates of male and female were 6.64% and 24.01250%, respectively (蠂 ~ 2 = 5.65%, P < 0.05), and there was no significant difference between them (蠂 ~ 2 = 8.05%, P < 0.05). There was no significant difference in drug resistance rate among different age groups (蠂 ~ 2 / 5.34 / P 0.05 ~ 0. 05 MDR = 8 / 13). The drug resistance rates of second line anti-tuberculosis drugs were OFX and pass (5 / 13 CS4 / 13% LVFX and MOX respectively) from high to low. Conclusion Wenzhou is a city where the drug resistance rate is 1 / 4 / CPM / 1 / 13 ~ 1 / 13 ~ (1 / 3). Conclusion the drug resistance rate of the second line anti-tuberculosis drugs is in the order of OFX and pass (all of them are 5 / 13) CS4 / 13% LVFX and MOX (all of which are 1 / 4 / CPM / 1 / 13). Conclusion Wenzhou is the second line of anti-tuberculosis drug resistance. The epidemic situation of MDR-TB in the city is relatively serious. The second line anti-tuberculosis drug sensitivity test should be carried out to strengthen the detection and treatment management of drug-resistant tuberculosis patients.
【作者单位】：温州市疾病预防控制中心;永嘉县疾病预防控制中心;瑞安市疾病预防控制中心;文成县疾病预防控制中心;
【基金】：温州市科技项目(No.Y20150292)~~
【分类号】：R446.5;R52

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