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目的对广东口岸出入境人员肺结核患者耐药情况进行分析,为口岸结核病监测、防控和直接面视下服药的全程督导管理(Directly Observed Treatment,DOT)工作提供依据。方法采集广东口岸出入境人员疑似结核感染者连续3 d晨痰,采用液体、固体培养基联合进行细菌分离培养,用液体比例法(MGIT 960)对结核分枝杆菌培养阳性菌株进行一线药物敏感性检测,耐多药结核(MDR-TB)菌株进行二线药物敏感性检测。用Excel、SPSS 18.0统计软件,对涂阳患者、初治和复治患者、输入性结核患者的耐药情况和性别、年龄与结核耐药率的关系进行统计分析。结果 2009—2014年,广东口岸共发现8 755例肺结核疑似感染患者,其中489例结核分枝杆菌培养阳性菌株完成一线药物敏感性检测。一线药总耐药率为18.61%,耐药率顺位依次为异烟肼(H)12.68%、链霉素(S)9.82%、利福平(R)4.91%、吡嗪酰胺(Z)3.07%和乙胺丁醇(E)1.23%。耐多药结核分枝杆菌二线抗结核药物耐药率顺位分别为乙硫异烟胺(ETH)15.79%、对氨基水杨酸(PAS)10.53%、氧氟沙星(OFX)5.26%、阿米卡星(AK)5.26%、卷曲霉素(CM)5.26%。涂阳肺结核耐药率为19.57%,其中初治患者的涂阳肺结核耐药率为18.67%,复治患者的涂阳肺结核耐药率为23.53%。性别间耐药率(χ2=0.10,P>0.05)和耐多药(MDR)率(χ2=0.91,P>0.05)差异均无统计学意义。15~59岁青中年人群分别占初治单耐药结核(SDR-TB)和MDR-TB患者的80.85%和76.92%。复治患者耐R率10.61%、耐Z率9.09%和MDR率9.09%,分别高于初治患者的4.02%、2.13%和3.07%,差异均具有统计学意义(χ2=5.31,P<0.05;χ2=9.31,P<0.05;χ2=5.54,P<0.05)。结论广东口岸存在一定耐药结核病传播风险,加强结核病患者的耐药性监测力度和高效的DOT,对预防耐药结核的跨国界传播十分必要。
Objective To analyze the drug resistance of pulmonary tuberculosis patients who exit and exit at the port of entry in Guangdong and provide the basis for monitoring the tuberculosis, preventing and controlling the direct observation of the medication (DOT) under the direct view of the port. Methods Acquired sputum from patients with suspected tuberculosis in entry and exit of Guangdong Province for 3 consecutive days were collected. Bacteria were isolated and cultured by liquid and solid culture medium. The first-line drug sensitivity of Mycobacterium tuberculosis culture positive strain was determined by liquid ratio method (MGIT 960) Detection, MDR-TB strains were tested for second-line drug susceptibility. Statistical analysis was conducted by using Excel and SPSS 18.0 statistical software on the relationship between drug-resistant status, sex, age and tuberculosis resistance rate among smear-positive patients, newly diagnosed and retreatment patients, and imported tuberculosis patients. Results A total of 8 755 cases of suspected pulmonary tuberculosis infection were found in Guangdong port from 2009 to 2014. Among them, 489 positive cases of Mycobacterium tuberculosis were tested for first-line drug susceptibility. The first-line drug resistance rate was 18.61%. The order of resistance rate was 12.68% of isoniazid (H), 9.82% of streptomycin (S), 4.91% of rifampicin, 3.07% and ethambutol (E) 1.23%. The resistance rates of second-line multidrug-resistant Mycobacterium tuberculosis second-line anti-TB drugs were 15.79% for ETH, 10.53% for PAS, 5.26% for OFX, Amikacin (AK) 5.26%, Capreomycin (CM) 5.26%. The positive rate of smear-positive pulmonary tuberculosis was 19.57%. Among them, the rate of smear-positive pulmonary tuberculosis was 18.67% in initial treatment and 23.53% in retreatment. There was no significant difference in the drug resistance rate between sexes (χ2 = 0.10, P> 0.05) and MDR (χ2 = 0.91, P> 0.05). Middle-aged people aged 15-59 years accounted for 80.85% and 76.92% of patients with newly diagnosed single-drug-resistant tuberculosis (SDR-TB) and MDR-TB, respectively. The patients with retreatment had R rate of 10.61%, resistance to Z rate of 9.09% and MDR rate of 9.09%, respectively, which were significantly higher than 4.02%, 2.13% and 3.07% of those of the newly diagnosed patients respectively (χ2 = 5.31, P <0.05 ; χ2 = 9.31, P <0.05; χ2 = 5.54, P <0.05). Conclusions There is a certain risk of transmission of drug-resistant TB in Guangdong ports. Strengthening drug resistance monitoring and efficient DOT in TB patients is necessary to prevent transboundary spread of drug-resistant TB.