结核分枝杆菌痰培养阳性肺结核患者对一线抗结核药耐多药情况分析

doi:10.13481/j.1671-587x.20150539

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (05): 1080-1084.doi: 10.13481/j.1671-587x.20150539

结核分枝杆菌痰培养阳性肺结核患者对一线抗结核药耐多药情况分析

殷雨天¹, 张靓², 张越¹, 蒋玲玲¹, 王钰涵¹, 王瑞¹, 张鹏¹, 李波¹

1. 吉林大学公共卫生学院流行病与卫生统计学教研室, 吉林长春 130021;
2. 吉林省结核病医院胸外科, 吉林长春 130500

收稿日期:2015-04-14 发布日期:2015-09-29
通讯作者: 李波,教授,硕士研究生导师(Tel:0431-85619451,E-mail:li_bo@jlu.edu.cn) E-mail:li_bo@jlu.edu.cn
作者简介:殷雨天(1990-),女,陕西省南郑县人,在读医学硕士,主要从事慢性病流行病学方面的研究。
基金资助:
吉林省卫计委科研基金资助课题(2011Z059)

Analysis on multidrug-resistant situation of first-line anti-tuberculosis drugs in tuberculosis patients with positive sputum Mycobacterium tuberculosis culture

YIN Yutian¹, ZHANG Liang², ZHANG Yue¹, JIANG Lingling¹, WANG Yuhan¹, WANG Rui¹, ZHANG Peng¹, LI Bo¹

1. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, China;
2. Department of Thoracic Surgery, Tuberculosis Hospital, Jilin Province, Changchun 130500, China

Received:2015-04-14 Published:2015-09-29

摘要/Abstract

摘要：

目的:分析初治和复治结核分枝杆菌痰培养阳性的肺结核患者对4种一线抗结核药的耐多药(MDR)情况,了解抗结核药耐药现状和形势。方法:选取结核分枝杆菌痰培养阳性患者395例,按中国防痨协会《结核病诊断细菌学检验规程》的要求进行菌种鉴别试验。采用WHO推荐比例法对阳性分离菌株进行药物敏感性检测,计算每种一线药的耐药率及4种一线药的MDR情况。计算初、复治患者的MDR率。结果:4种一线抗结核药物耐药率顺位依次为链霉素(93/395,23.5%),异烟肼(88/395,22.3%),利福平(58/395,14.7%),乙胺丁醇(23/395,5.8%)。初治和复治组患者耐药均以耐链霉素和异烟肼为主,且耐药顺位一致,复治组患者利福平耐药率(17.4%)高于初治组(6.9%)(χ²=6.714,P=0.010)。至少同时对异烟肼和利福平耐药者33例,总MDR率为8.4%,复治患者MDR率(10.2%)高于初治患者MDR率(2.9%)(χ²=5.263,P=0.022)。初、复治组患者MDR形式均以同时耐异烟肼、利福平和链霉素为主,分别为2例(2.0%)和13例(4.4%)。结论:结核分枝菌痰培养阳性肺结核患者耐药频度顺位依次为链霉素、异烟肼、利福平和乙胺丁醇。复治组患者利福平耐药率、MDR率均高于初治组。初、复治组耐多药形式均以同时耐异烟肼、利福平和链霉素为主。

关键词: 肺结核, 耐药, 结核分枝杆菌

Abstract:

Objective To analyze the multidrug resistant(MDR) situation of initial and retreatment tuberculosis patients with positive sputum Mycobacterium tuberculosis culture to four frontline anti-tuberculosis (anti-tb) drugs, and to learn the resistance status and situation of anti-tb drugs. Methods A total of 395 patients with positive sputum Mycobacterium tuberculosis culture were selected.The species identification experiment was carried out according to the China Tuberculosis Association Tuberculosis Diagnostic Bacteriology Inspection Procedures.The drug sensitivities of positive isolates sputum were detected by WHO recommended ratio method.The risistant rates of each first-line drug and MDR situation of the four kinds of first-line drugs were calculated.The multi-drug resistant rate of the patients in initial and retreatment groups were detected. Results The order of resistant rates of four first-line anti-tb drugs in the 395 patients were streptomycin (93/395,23.5%),isoniazid (88/395,22.3%),rifampin (58/395,14.7%),ethambutol (23/395,5.8%).The patients in initial treatment group and retreatment group were resistant to streptomycin and isoniazid,and the resistance order was consistent;the resistant rate of rifampin(17.4%) of the patients in retreatment group was higher than that in initial group (6.9%) (χ²=6.714,P=0.010).At the same time there were at least 33 cases of isoniazid and rifampin resistance,and the total MDR rate was 8.4%;the MDR rate of the patients in retreatment group (10.2%) was higher than that in initial group (2.9%) (χ²=5.263,P=0.022). The main MDR forms of the patients in initial(2,2.0%) and retreatment(13,4.4%) groups were resistant to isomiazid,rifampin,and streptomycin. Conclusion The order of drug-resistant is streptomycin,isoniazid,rifampicin,and ethambutol.The resistant rate of rifampin and the MDR rate of the patients in retreatment group are higher than those in initial group.The main MDR forms of patients in initial and retreatment groups are resistant to isomiazid,rifampin,and streptomycin.

Key words: pulmonary tuberculosis, resistance, Mycobacterium tuberculosis

中图分类号:

R195.4

殷雨天, 张靓, 张越, 蒋玲玲, 王钰涵, 王瑞, 张鹏, 李波. 结核分枝杆菌痰培养阳性肺结核患者对一线抗结核药耐多药情况分析[J]. 吉林大学学报(医学版), 2015, 41(05): 1080-1084.

YIN Yutian, ZHANG Liang, ZHANG Yue, JIANG Lingling, WANG Yuhan, WANG Rui, ZHANG Peng, LI Bo. Analysis on multidrug-resistant situation of first-line anti-tuberculosis drugs in tuberculosis patients with positive sputum Mycobacterium tuberculosis culture[J]. Journal of Jilin University Medicine Edition, 2015, 41(05): 1080-1084.

参考文献

[1] Oxlade O,Murray M. Tuberculosis and poverty:why are the poor at greater risk in Indian[J].PLoS One,2012,7(11):e47533.

[2] World Health Organization.Global tubereulosis control:surveillanee planning,finaneing.WHO Report 2009.WHO/HTM/TB/2009.411[C].Geneva:WHO,2009.

[3] Mignone F,Codecasa LR,Scolfaro C,et al.The spread of drug-resistant tuberculosis in children:an Italian case series[J].Epidemiol Infect,2014,142(10):2049-2056.

[4] Ferrer GC,da Silva RM,Ferrer KT,et al.The burden of disease due to tuberculosis in the state of Santa Catarina,Brazil[J].J Bras Pneumol,2014,40(1):61-68.

[5] 李亚楠,何立新,朱建良,等.石家庄地区耐多药肺结核病患者耐药情况及相关因素分析[J].医学动物防制,2014,30(8):845-847.

[6] 中国防痨协会.结核病诊断细菌学检验规程[J].中国防痨杂志,1996,18(1):30-33.

[7] World Health Organization.Policy guidance on drug-susceptibility testing (DST) of second-line anti-tuberculosis drugs[C].Geneva WHO,2008.

[8] 米热班·热夏提.371例肺结核患者耐药情况分析 [D].乌鲁木齐:新疆医科大学,2012.

[9] 李燕芬,赵梅桂,刘振扬,等.初复治肺结核患者160例耐药情况临床分析[J].当代医学,2014,20(14):54-55.

[10] 肖东楼,赵明刚,王宇.全国结核病防治规划实施工作指南(2008 版) [M].北京:中国协和医科大学出版社,2009.

[11] Dara M,Dadu A,Kremer K,et al.Epidemiology of tuberculosis in WHO European Region and public health response[J].Eur Spine J,2013,22(Suppl 4):549-555.

[12] Diel R,Vandeputte J,de Vries G,et al.Costs of tuberculosis disease in the European Union:a systematic analysis and cost calculation[J].Eur Respirat J,2014,43(2):554-565.

[13] Makwakwa L,Sheu ML,Chiang CY,et al.Patient and heath system delays in the diagnosis and treatment of new and retreatment pulmonary tuberculosis cases in Malawi[J].BMC Infect Dis,2014,14:132.

[14] 范常龙,王博,纪滨英.105例肺结核痰结核菌耐药情况分析[J].黑龙江医药,2014,27(4):850-851.

[15] 车洋,于梅,许国章,等.332例复治肺结核患者一线抗结核药物耐药情况分析[J].中国卫生检验杂志,2014,24(23):3481-3483.

[16] 翟广,李波,李玉芹,等.利福喷丁与利福平治疗肺结核疗效和安全性的Meta分析[J].吉林大学学报:医学版,2011,37(3):523-528.

[17] 王黎霞,成诗明,陈明亭,等.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.

[18] 全国结核病流行病学抽样调查技术指导组.2000年全国结核病流行病学抽样调查报告[J].中国防痨杂志,2002,24(2):3-46.

[19] 彭亦平,谭彩萍,史安良.81例耐药肺结核临床分析[J].临床肺科杂志,2012,17(1):84-85.

[20] 高华强,陈奇峰,金法祥,等.绍兴市肺结核耐药情况分析[J].浙江预防医学,2014,26(3):242-244,262.

结核分枝杆菌痰培养阳性肺结核患者对一线抗结核药耐多药情况分析

Analysis on multidrug-resistant situation of first-line anti-tuberculosis drugs in tuberculosis patients with positive sputum Mycobacterium tuberculosis culture

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	杨莉, 王雪雯, 周明, 张帆. As₂O₃联合γ分泌酶抑制剂MW167对人肝癌HepG₂/ADM细胞耐药性的影响[J]. 吉林大学学报(医学版), 2018, 44(01): 1-7.
[2]	周浩泉, 储新民, 戴媛媛, 代传林, 潘家华. 婴幼儿非发酵菌感染的临床特征和耐药分析[J]. 吉林大学学报(医学版), 2017, 43(05): 975-979.
[3]	何悦铭, 康丽花, 王倩, 王迦南, 宋艳秋. 雌激素受体阳性乳腺癌患者内分泌耐药机制的研究进展[J]. 吉林大学学报(医学版), 2017, 43(02): 454-458.
[4]	刘相良, 袁铭成, 纪伟, 徐鑫宇, 梅起腾, 李理, 陈晓, 李薇. 长链非编码RNA在肺癌发生发展中作用的研究进展[J]. 吉林大学学报(医学版), 2017, 43(02): 450-453.
[5]	黄燕, 陈玉坤, 冀旭峰, 李涵. ICU患者深部真菌感染的病原菌分布及耐药性分析[J]. 吉林大学学报(医学版), 2017, 43(01): 111-114.
[6]	惠双, 郭宏强. DNA-PKcs介导多药耐药恶性胶质瘤细胞化疗抗性及分子机制[J]. 吉林大学学报(医学版), 2016, 42(05): 877-881.
[7]	姜慧, 张桐菲, 杨鹤, 徐召南, 毕也, 孙抒, 张泽兵, 贾杰. 人舌鳞状细胞癌顺铂耐药细胞株CAL-27/DDP的建立及其生物学评价[J]. 吉林大学学报(医学版), 2016, 42(03): 506-511.
[8]	冯晓朦, 王晶莹, 时景伟, 李威, 高申, 冯雪飞, 谢风. 血清ADA水平和T-spot.TB联合检测在肺结核诊断中的应用[J]. 吉林大学学报(医学版), 2016, 42(02): 306-310.
[9]	张鹏, 车丽赫, 郭志敏, 娄丽新, 鲍万国, 李玉香. 泌尿系统感染患者病原菌的分布及其耐药性分析[J]. 吉林大学学报(医学版), 2015, 41(03): 593-598.
[10]	张晓伟，刘晓峰，田春迎，于秀艳. 肿瘤住院患者病原菌感染情况及其耐药性分析[J]. 吉林大学学报(医学版), 2014, 40(06): 1314-.
[11]	王槐栋，张晓天，张超，关世慧，董君雪，牟佳，王放，郑敬彤. DNA测序技术在不同药物压力下大肠埃希菌耐药性产生机理研究中的应用[J]. 吉林大学学报(医学版), 2014, 40(01): 109-112.
[12]	薛惠荣1，王丽萍2，耿嘉男2，崔满华3. 缺氧诱导因子-1α基因沉默逆转卵巢癌细胞SKOV3/DDP耐药性的机制[J]. 吉林大学学报(医学版), 2013, 39(6): 1103-1107.
[13]	周佳琦，史红艳，徐花，黄金凤，孙延波. 长春地区部分医院革兰阴性杆菌16S rRNA甲基化酶基因的检测及其意义[J]. 吉林大学学报(医学版), 2013, 39(5): 933-937.
[14]	王丹妹，何佟，吉丽敏，林峰，林容，林堂昌，莫燕娜. 中国海南黎族人群LMP2/LMP7基因多态性与肺结核病的关联性[J]. 吉林大学学报(医学版), 2013, 39(4): 786-790.
[15]	李彤，张娟，张桂珍，徐江涛，张萍，蒋俊，孙秀华，杜珍武. TLR8基因多态性与中国东北地区汉族肺结核病的关联性分析[J]. 吉林大学学报(医学版), 2013, 39(3): 584-587.