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目的调查长沙市某院就诊肺结核患者耐药情况。方法收集2013-2014年湖南省胸科医院就诊结核患者6 535例,采用绝对浓度法测定病人对异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星6种常用抗结核药物的敏感性。结果经痰结核菌培养阳性1 140例,初治患者591例,复治患者549例;耐药肺结核患者443例,总耐药率为38.86%(443/1 140),其中初治患者耐药率为25.38%(150/591),复治患者耐药率为53.37%(293/549)。在耐多药患者中,耐多药率为23.7%(270/1 140),复治患者的耐多药率35.15%(193/549)高于初治耐多药患者13.03%(77/591),复治患者在阳性率、耐药率和耐多药率方面均高于初治患者,其差异均有统计学意义(分别χ2=104.91,P=0.000;χ2=93.84,P=0.000;χ2=77.09,P=0.000)。根据性别分类,男性患者阳性率19.46%高于女性患者阳性率13.32%(χ2=37.75,P=0.000),但女性患者分别在单耐RFP和单耐SM均高于男性患者,差异有统计学意义(分别χ2=4.152,P=0.042;χ2=10.257,P=0.001)。RFP、INH和SM为单药耐药率最高的前三位,分别为28.50%、28.42%和21.58%。而在MDRTB中,以同时耐利福平、异烟肼和链霉素所占比例最高,达32.2%(87/270)。结论长沙市某院就诊肺结核患者的总耐药率和耐多药率均较高,MDR-TB中,菌株中以异烟肼、利福平和链霉素三种药物同时耐药的患者数最高,中老年人群是结核病及耐药结核的高发人群,复治患者在阳性率、耐药率和耐多药率方面均高于初治患者。
Objective To investigate the drug resistance of tuberculosis patients in a hospital in Changsha City. Methods Totally 6 535 TB patients were collected in Hunan Thoracic Hospital from 2013 to 2014. The patients were treated with absolute concentration method for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin, Star 6 kinds of commonly used anti-TB drug sensitivity. Results The results showed that there were 1 140 positive cases of sputum bacterium, 591 cases of initial treatment and 549 cases of retreatment; 443 cases of resistant tuberculosis, with a total resistance rate of 38.86% (443/1 140) The rate of remission was 53.37% (293/549) in 25.38% (150/591) patients. Among multidrug-resistant patients, MDR rates were 23.7% (270/1 140), those of retreatment were 35.15% (193/549) higher than 13.03% (77/591) of MDR-MDR patients ), The patients in retreatment were higher than those in newly diagnosed patients in positive rate, drug resistance rate and multidrug resistance rate (χ2 = 104.91, P = 0.000; χ2 = 93.84, P = 0.000; χ2 = 77.09, P = 0.000). According to the gender classification, the positive rate of male patients was 19.46% higher than that of female patients (χ2 = 37.75, P = 0.000), but the female patients were higher than male patients in single-resistant RFP and single-resistant SM patients respectively Significance (χ2 = 4.152, P = 0.042; χ2 = 10.257, P = 0.001, respectively). RFP, INH and SM were the top three drug resistance rates of 28.50%, 28.42% and 21.58% respectively. In MDRTB, at the same time, the highest proportion of rifampicin, isoniazid and streptomycin reached 32.2% (87/270). Conclusion The total drug resistance rate and multidrug-resistant rate of patients with tuberculosis in a hospital in Changsha are high. Among MDR-TB patients, the number of patients with simultaneous drug resistance of isoniazid, rifampicin and streptomycin was the highest , Middle-aged and elderly people are the high incidence of tuberculosis and drug-resistant TB, and the patients with re-treatment are higher in the positive rate, drug-resistant rate and multi-drug resistance rate than the newly diagnosed patients.