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目的:了解武义县结核分枝杆菌耐药的发生率及特点,获得该地结核分枝杆菌耐药性水平资料,对涂阳结核病人治疗中影响治愈率的因素进行分析。方法:采用绝对浓度间接法对98株结核分枝杆菌进行4种药物的敏感性试验。先以培养获得分枝杆菌,再上送金华市疾控中心进行菌株鉴定和药敏试验,后由金华市疾控中心将菌株鉴定和药敏试验结果返回。结果:227例涂阳肺结核患者经培养后共获得98株结核分枝杆菌,均为人型结核菌,无牛型结核菌;共检出耐药菌株31株,占31.7%(31/98),初治涂阳患者菌株耐药的有24株,占27.6%(24/87),复治涂阳肺结核患者菌株耐药的有7株,占63.6%(7/11)。31株耐药菌株中,耐异烟肼7株(22.6%),耐利福平11株(35.5%),耐链霉素9株(29.0%),耐乙胺丁醇4株(12.9%);同时耐2种药物的13株(41.9%),耐3种药物的5株(16.1%),还有2株耐4种药物(耐HRES,6.1%)。结论:该县初治耐药率高于浙江省耐药监测结果,复治耐药率与全省耐药监测结果基本相符。结核菌耐药是影响治愈率的主要因素,对临床用药具有重要的指导意义,早期、联用、适量、规律、全程用药是治疗肺结核的关键。
OBJECTIVE: To understand the incidence and characteristics of Mycobacterium tuberculosis resistance in Wuyi County, to get the data on the level of Mycobacterium tuberculosis in this area, and to analyze the factors influencing the cure rate of smear-positive TB patients. Methods: The sensitivity of 4 drugs to 98 strains of Mycobacterium tuberculosis was tested by absolute concentration indirect method. First to obtain mycobacterium culture, and then sent to Jinhua CDC strain identification and drug susceptibility testing, after the Jinhua CDC strain identification and drug sensitivity test results returned. Results: A total of 98 strains of Mycobacterium tuberculosis were obtained from 227 smear positive pulmonary tuberculosis patients, all of which were human type Mycobacterium tuberculosis without bovine mycobacterium tuberculosis. A total of 31 resistant strains (31.7%, 31/98) Among 24 newly diagnosed smear-positive patients, 24 strains were resistant, accounting for 27.6% (24/87), and 7 strains were resistant to remitting smear-positive pulmonary tuberculosis (63.6%, 7/11). Of the 31 resistant strains, 7 were resistant to isoniazid (22.6%), 11 were resistant to rifampin (35.5%), 9 were resistant to streptomycin (29.0%), 4 were resistant to ethambutol (12.9% ); 13 (41.9%) were resistant to 2 drugs, 5 (16.1%) were resistant to 3 drugs and 2 were resistant to 4 drugs (HRES resistance, 6.1%). Conclusion: The initial drug resistance rate in this county is higher than that of Zhejiang province. The drug resistance rate of retreatment is consistent with that of the province. Mycobacterium tuberculosis drug resistance is the main factor affecting the cure rate, and has important guiding significance for clinical medication. Early, combined, appropriate, regular, full-course medication is the key to the treatment of tuberculosis.