论文部分内容阅读
目的 分析结核性胸膜炎患者对抗结核药物的耐药特点,为临床制定合理的化疗方案及结核病的防治提供依据.方法 选取2014年1月至2016年12月首都医科大学附属北京胸科医院收治的临床诊断为结核性胸膜炎患者265例为研究对象,采用绝对浓度法测定来自于结核性胸膜炎患者的265株结核分枝杆菌对利福平(RFP)、异烟肼(INH)、链霉素(Sm)、乙胺丁醇(EMB)、阿米卡星(Am)、卷曲霉素(Cm)、乙硫异烟胺(Eto)、对氨基水杨酸(PAS)、左氧氟沙星(Lfx)和利福布汀(Rfb)的敏感性.结果 结核性胸膜炎患者对10种药物的总耐药率为39.25％(104/265),其中初治和复治患者总耐药率分别为30.05％(64/213)和76.92％(40/52),差异有统计学意义(x2=28.52,P＜0.001).初治患者耐药顺位为;Sm(38/213,17.84％)＞INH(34/213,15.96％)＞RFP(21/213,9.86％)＞Rfb(18/213,8.45％)＞Lfx(14/213,6.57％)＞PAS(10/213,4.69％)=Crn(10/213,4.69％)＞EMB(8/213,3.76％) ＞Am(7/213,3.29％)＞Eto(6/213,2.82％).复治患者耐药顺位为:RFP(28/52,53.85％)＞Sm(27/52,51.92％)=INH(27/52,51.92％)＞Rfb(23/52,44.23％)＞Lfx(22/52,42.31％)＞PAS(13/52,25.00％)＞Eto(10/52,19.23％) ＞Am(8/52,15.38％)＞EMB(7/52,13.46％)＞Cm(5/52,9.62％).耐多药率和广泛耐药率分别为10.19％(27/265)和2.64％(7/265),其中初治患者分别为6.57％(14/213)和0.47％(1/213),复治患者分别为25.00％(13/52)和11.54％(6/52),初、复治患者的耐多药率和广泛耐药率的差异有统计学意义(x2值分别为15.51、19.91,P值均＜0.001).结论 结核性胸膜炎同样存在原发耐药和继发耐药问题,应根据药物敏感性试验结果选择科学有效的化疗方案.“,”Objective To understand the drug resistant patterns in patients with pleural tuberculosis (TB)and to provide evidences for development of the proper clinical treatment regimens as well as the prevention and con-trol methods.Methods The Mycobacterium tuberculosis clinical isolates were collected from 265 culture positive(Lowenstein-Jensen medium) pleural TB patients,who hospitalized at Beijing Chest Hospital from January 2014 toDecember 2016.Drug susceptibility testing (DST) was performed to the following 10 antkTlB drugs by using theproportion method:rifampicin (RFP),isoniazid (INH),streptomycin (Sm),ethambutol (EMB),amikacin (Am),capreomycin (Cm),ethionamide (Eto),para-aminosalicylic acid (PAS),levofloxacin (Lfx) and rifabutin (Rfb).Results The overall drug-resistance rate,namely was resistant to at least one of the 10 anti-TB drugs,in thepatients with pleural TB was 39.25％ (104/265),of which the drug resistance rate was 30.05％ (64/213) and76.92％ (40/52) in the new patients and previously treated patients respectively,the diffevence was statisticallysignificant (x2 28.52,P＜0.001).In the new patients,the drug resistant rates of the 10 anti-TB drugs from highto low were；Sm (38/213,17.84％)＞INH (34/213,15.96％)＞RFP (21/213,9.86％)＞Rfb (18/213,8.45％)＞Lfx (14/213,6.57％)＞PAS (10/213,4.69％)=Cm (10/213,4.69％)＞EMB (8/213,3.76％)＞Am (7/213,3.29％)＞Eto (6/213,2.82％);in the retreatment patients,the order of the drug-resistant rates from high to lowwas；RFP (28/52,53.85％)＞Sm (27/52,51.92％)=INH (27/52,51.92％)＞Rfb (23/52,44.23％)＞Lfx(22/52,42.31％) ＞PAS (13/52,25.00％) ＞ Eto (10/52,19.23％) ＞Am (8/52,15.38％) ＞ EMB (7/52,13.46％)＞Cm (5/52,9.62％).The overall multi-drug resistance (MDR) rate and the overall extensively drugresistance (XDR) rate were 10.19％ (27/265) and 2.64％ (7/265) in all patients with pleural TB,and those rateswere 6.57％ (14/213) and 0.47％ (1/213) in the new cases,and 25.00％ (13/52) and 11.54％ (6/52) in theretreatment cases.The differences of the overall drug resistant rate between the overall MDR rate and the overallXDR rate were statistically significant (x2 =15.51,P＜0.001;x2 =19.91,P＜0.001).Conclusion There areprimary and acquired drug resistances in patients with pleural tuberculosis.DST should be routinely performed tothose patients and the effective treatment regiments should be designed based on the DST results.