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目的了解海南省耐药结核病的流行现状,为制定结核病防治工作策略提供科学依据。方法收集海南省各市(县)2015年1月—12月期间发现的1543例涂阳肺结核患者的痰标本,进行结核分枝杆菌培养、菌型鉴定。采用比例法进行6种抗结核药物[利福平(RFP,R)、异烟肼(INH,H)、链霉素(Sm,S)、乙胺丁醇(EMB,E)、氧氟沙星(Ofx,O)、卡那霉素(KM,K)]的药物敏感性试验。结果 1543例涂阳肺结核患者中,1339例为结核分枝杆菌复合群,其中总耐药率为20.9%(280/1339),初治涂阳肺结核患者总耐药率及复治涂阳肺结核患者总耐药率分别为17.3%(197/1139)和41.5%(83/200),复治患者总耐药率高于初治患者,两组之间差异有统计学意义(P<0.01)。总单耐药率为10.5%(140/1339),初治患者单耐药率为10.4%(119/1139),复治患者为10.5%(21/200),两组间差异无统计学意义(P>0.05)。多耐药率为3.6%(48/1339),其中初治患者多耐药率为3.6%(41/1139),复治患者为3.5%(7/200),两组间差异无统计学意义(P>0.05)。总耐多药率为6.9%(92/1339),其中初治患者耐多药率为3.2%(37/1139),复治患者为27.5%(55/200),两组间差异有统计学意义(P<0.01)。耐单药率顺位由高到低依次为Sm=INH>RFP>Ofx>EMB>Km。结论海南省结核病的耐药情况不容乐观,今后需要采取全面、积极的干预措施遏制耐药结核病的流行。
Objective To understand the prevalence of drug-resistant tuberculosis in Hainan Province and provide a scientific basis for the development of tuberculosis prevention and control strategies. Methods A total of 1543 sputum smear positive sputum smear positive smear positive pulmonary TB patients from January to December in 2015 in cities and counties of Hainan Province were collected for mycobacterium tuberculosis culture and bacterial identification. Six anti-TB drugs [rifampin (RFP, R), isoniazid (INH, H), streptomycin (Sm, S), ethambutol (EMB, E) (Ofx, O), kanamycin (KM, K)] drug sensitivity test. Results Of the 1543 smear positive pulmonary tuberculosis patients, 1339 were Mycobacterium tuberculosis complex, in which the total drug resistance rate was 20.9% (280/1339). The total drug resistance rate of newly smear positive pulmonary tuberculosis patients and patients with retreatment smear positive pulmonary tuberculosis The total drug resistance rates were 17.3% (197/1139) and 41.5% (83/200), respectively. The total drug resistance rate of retreatment patients was higher than that of the newly diagnosed patients. There was significant difference between the two groups (P <0.01). The overall single drug resistance rate was 10.5% (140/1339). The single drug resistance rate in newly diagnosed patients was 10.4% (119/1139) and that in retreatment was 10.5% (21/200). There was no significant difference between the two groups (P> 0.05). The rate of multidrug resistance was 3.6% (48/1339), among them, the rate of multidrug resistance was 3.6% (41/1139) in initial treatment and 3.5% (7/200) in retreatment, and there was no significant difference between the two groups (P> 0.05). The overall rate of MDR was 6.9% (92/1339). Among them, the rate of MDR was 3.2% (37/1139) in initial treatment and 27.5% (55/200) in retreatment, the difference was statistically significant Significance (P <0.01). Resistance to monoglycemic order descending order of Sm = INH> RFP> Ofx> EMB> Km. Conclusion The resistance of TB in Hainan Province is not optimistic, and comprehensive and positive interventions will be needed to stop the spread of drug-resistant TB.