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目的了解肺结核患者痰结核分枝杆菌临床分离株对氧氟沙星的耐药情况,为氧氟沙星在抗结核化疗中的合理应用提供科学依据。方法2007年8月—2008年3月上海市肺科医院收治的痰培养阳性的肺结核患者,全部培养阳性菌株进行菌种鉴定及5种抗结核药物(异烟肼、利福平、氧氟沙星、链霉素、乙胺丁醇)的耐药性测试。结果233例MTB临床株对氧氟沙星耐药率为24.9%,低于对一线药物的耐药率。初治肺结核患者氧氟沙星耐药率为12.3%,复治肺结核患者为46.0%,差异有统计学意义(χ2=31.16,P<0.01);首次复治患者氧氟沙星耐药率为41.7%,其他复治患者为49.0%,差异无统计学意义(χ2=0.46,P=0.50);耐多药组氧氟沙星耐药率为57.8%,多耐药组为35.1%,单耐药组为6.3%,一线药物敏感组为5.2%,其中耐多药组与其他3组、多耐药组与一线药物敏感组的耐药率差异有统计学意义(χ2=6.04、10.52、59.87、17.97,P均<0.05);青年组氧氟沙星耐药率29.5%,中年组为26.5%,老年组为14.0%,老年组与青年组的耐药率差异有统计学意义(χ2=5.10,P=0.02);原发性氧氟沙星耐药率9.9%,继发性氧氟沙星耐药率78.4%,差异有统计学意义(χ2=96.47,P<0.01)。结论耐多药肺结核氧氟沙星耐药率明显高于其他耐药类型的肺结核。结核菌对氧氟沙星的继发耐药率明显高于原发耐药率。氧氟沙星的不恰当应用极易导致氧氟沙星的耐药。
Objective To understand the drug resistance of the clinical isolates of sputum Mycobacterium tuberculosis to ofloxacin in patients with pulmonary tuberculosis and to provide a scientific basis for the rational application of ofloxacin in anti-tuberculosis chemotherapy. Methods From August 2007 to March 2008, patients with sputum culture positive pulmonary tuberculosis who were admitted to Shanghai Pulmonary Hospital were all tested for positive bacteria strains and five kinds of anti-TB drugs (isoniazid, rifampicin, ofloxacin Star, streptomycin, ethambutol) drug resistance test. Results 233 cases of MTB clinical strains of ofloxacin resistance was 24.9%, lower than the rate of resistance to first-line drugs. The initial resistance rate of ofloxacin in patients with pulmonary tuberculosis was 12.3%, and that of retreatment pulmonary tuberculosis was 46.0% (χ2 = 31.16, P <0.01). The initial resistance rate of ofloxacin was 41.7%, and other retreatment patients was 49.0%, the difference was not statistically significant (χ2 = 0.46, P = 0.50); the resistance rate of ofloxacin was 57.8% in MDR group and 35.1% in MDR group The drug resistance was 6.3% in the first-line drug-sensitive group and 5.2% in the first-line drug-sensitive group, and the difference was statistically significant between the multidrug-resistant group and the first-line drug-susceptible group (χ2 = 6.04,10.52, 59.87, 17.97, P <0.05). The resistance rate of ofloxacin in young group was 29.5%, in middle-aged group was 26.5%, in elderly group was 14.0%, there was significant difference in drug resistance rate between old group and young group χ2 = 5.10, P = 0.02). The drug resistance of the primary ofloxacin was 9.9% and the rate of the secondary of ofloxacin was 78.4%. The difference was statistically significant (χ2 = 96.47, P <0.01). Conclusion The resistance rate to ofloxacin in MDR-TB patients was significantly higher than that of other drug-resistant types of tuberculosis. Mycobacterium tuberculosis secondary toloxacin resistance was significantly higher than the primary resistance rate. Ofloxacin inappropriate application can easily lead to ofloxacin resistance.