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目的了解河南省滑县耐多药结核分枝杆菌的防控现状,为制定结核病防控措施提供参考。方法对2013年1月至2016年12月滑县中心医院结核病耐药监测点收集的经痰结核分枝杆菌培养呈阳性的菌株224株进行一线抗结核药物敏感试验,收集患者人口学资料,分析耐多药的影响因素。结果 1 752例肺结核患者中痰培养阳性928例。进一步行酸性罗氏培养,分离菌株263株。其中人型结核分枝杆菌224株、非结核分枝杆菌31株、牛型分枝杆菌8株。224株结核分枝杆菌中,对抗结核一线药物耐多药菌株31株,占13.84%。初治患者耐多药菌株比例明显低于复治患者,差异有统计学意义(P<0.01);多药耐药率排前4的组合分别为:异烟肼+链霉素、异烟肼+利福平、链霉素+利福平、异烟肼+利福平+链霉素。不同年龄、治疗史、户籍的患者分离出的结核分枝杆菌多药耐药率之间差异有统计学意义(P<0.05)。结论河南省滑县复治结核患者耐多药率明显高于国内平均水平,防控现状较为严峻,年龄、治疗史、户籍为耐多药的影响因素,应对复治患者根据药敏结果和影响因素做好分类管理,制定合理化给药方案,控制耐多药的发生率。
Objective To understand the status of prevention and control of multidrug-resistant Mycobacterium tuberculosis in Huaxian County, Henan Province, and to provide reference for making prevention and control measures of tuberculosis. Methods A total of 224 positive strains of Mycobacterium tuberculosis collected from the TB drug resistance surveillance center in Huaxian Central Hospital from January 2013 to December 2016 were tested for first-line antituberculosis drug susceptibility. Demographic data were collected and analyzed Multidrug resistance factors. Results A total of 928 sputum cultures were positive in 1 752 patients with pulmonary tuberculosis. Further line of acid Roche culture, isolates of 263 strains. Among them, 224 were human-type Mycobacterium tuberculosis, 31 were non-tuberculous mycobacteria and 8 were Mycobacterium bovis. Among the 224 strains of Mycobacterium tuberculosis, 31 strains were resistant to the first-line drug-resistant multi-drug of tuberculosis, accounting for 13.84%. The proportion of multidrug-resistant strains in newly diagnosed patients was significantly lower than that in retreatment patients (P <0.01). The top 4 multidrug resistance rates were isoniazid, streptomycin, isoniazid + Rifampicin, streptomycin + rifampin, isoniazid + rifampicin + streptomycin. The differences of multidrug resistance rate of Mycobacterium tuberculosis isolated from patients of different ages, treatment history and household registration were statistically significant (P <0.05). Conclusion The multi-drug resistance rate of retreatment tuberculosis patients in Huaxian County of Henan Province is significantly higher than the national average level, and the status of prevention and control is more serious. The age, treatment history and household registration are the influencing factors of multi-drug resistance. Factors to do a good job classification management, formulate a rational program of administration, control the incidence of multi-drug resistance.