浙江省结核病耐药状况分析

发布时间：2019-05-12 14:25

【摘要】：目的通过结核病耐药监测,了解浙江省结核病耐药状况,为耐药结核病疫情控制提供依据。方法在浙江省随机抽取30个县(区),对样本县(区)2013年7月1日—2014年6月30日发现的涂阳患者做细菌培养,将其中结核分枝杆菌(TB)培养阳性的菌株纳入耐药分析。结果共纳入1 010例涂阳患者,其中51例(5.05%)鉴定为非TB,936例(92.67%)鉴定为TB,23例(2.28%)培养细菌未生长。浙江省结核病总耐药率为30.88%,耐多药率为5.02%。其中初治耐药率29.22%,耐多药率3.21%;复治耐药率45.74%,耐多药率21.28%。13种纳入监测的抗结核药物均存在耐药现象,链霉素(SM)总耐药率最高(15.28%),氨基糖苷类相对较低(2.35%)。初治患者中SM耐药率最高(14.37%),耐药谱系比例较高的为耐SM、丙硫异烟胺、异烟肼(INH)、INH+SM和氧氟沙星+左氧氟沙星+莫西沙星;复治患者中INH耐药率最高(30.85%),耐药谱系比例较高的为耐SM、INH+利福平(RFP)、INH+RFP+SM、INH和RFP。复治患者总耐药率、耐多药率、一线抗结核药物耐药率以及对INH、RFP、SM、乙胺丁醇、卡那霉素和对氨基水杨酸的耐药率均比初治患者高(P0.05)。结论浙江省结核病患者初治耐药率较以往有所上升,表明耐药菌株的原发传播并未得到有效控制;复治耐药率和耐多药率均有所下降,表明实施标准短程化疗方案已取得一定成效;SM的高耐药率提示现有治疗方案中SM尚需商榷。
[Abstract]:Objective to understand the status of drug resistance of tuberculosis in Zhejiang Province through drug resistance surveillance, and to provide evidence for the control of drug resistance tuberculosis. Methods 30 counties (districts) were randomly selected from Zhejiang Province to culture smear positive patients from July 1, 2013 to June 30, 2014. The positive strains of Mycobacterium tuberculosis (TB) culture were included in the drug resistance analysis. Results A total of 1010 smear positive patients were included, of which 51 (5.05%) were identified as non-TB,936 (92.67%) as TB,23 (2.28%). The total drug resistance rate of tuberculosis in Zhejiang Province was 30.88%, and the multi-drug resistance rate was 5.02%. The drug resistance rate of the first treatment was 29.22%, and the multi-drug resistance rate was 3.21%. The retreatment resistance rate was 45.74%, and the multi-drug resistance rate was 21.28%. The total drug resistance rate of streptomycin (SM) was the highest (15.28%), and the aminoglycoside resistance rate was relatively low (2.35%). Among the newly diagnosed patients, the drug resistance rate of SM was the highest (14.37%). The proportion of drug resistance pedigree was SM, propylthionamines, isoniazid (INH), INH SM and ofloxacin levofloxacin mosifloxacin. The drug resistance rate of INH was the highest in retreated patients (30.85%). The proportion of drug resistance pedigree was SM,INH rifampicin (RFP), INH RFP SM,INH and RFP.. The total drug resistance rate, multi-drug resistance rate, first-line anti-tuberculosis drug resistance rate and resistance rate to INH,RFP,SM, ethambutol, kanamycin and aminosalicylic acid in retreated patients were higher than those in newly treated patients (P 0.05). Conclusion the initial drug resistance rate of tuberculosis patients in Zhejiang Province is higher than that in the past, which indicates that the primary transmission of drug-resistant strains has not been effectively controlled. The drug resistance rate and multi-drug resistance rate of retreatment decreased, indicating that the implementation of standard short-course chemotherapy regimen has achieved some results, and the high drug resistance rate of SM suggests that SM needs to be discussed in the existing treatment schemes.
【作者单位】：浙江省疾病预防控制中心;
【基金】：浙江省重大科技专项计划项目(2014C03034) 浙江省医药卫生科技计划项目(2015KYA056、2015KYB079)
【分类号】：R52

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