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目的 通过耐药监测了解中国西南地区肺结核患者的耐药状况.方法 选取2014-2015年重庆市、四川省、云南省的8个国家耐药监测点收集的610例涂阳肺结核患者的结核分枝杆菌临床分离株,采用固体比例法药物敏感性试验(简称“药敏试验”)对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(Sm)共4种一线抗结核药物及卡那霉素(Km)、氧氟沙星(Ofx)、卷曲霉素(Cm)、丙硫异烟胺(Pto)、对氨基水杨酸钠(PAS)共5种二线抗结核药物进行药敏试验检测.对9种药物的总耐药率、单耐药率、耐药顺位、耐多药率,以及不同地区、不同年份耐药率的差异进行分析.结果 结核分枝杆菌分离株对9种抗结核药物的总体耐药率和耐多药率分别是19.51％(119/610)和5.74％(35/610).各抗结核药物的耐药顺位由高到低依次为INH(11.97％, 73/610)、Sm(10.66％, 65/610)、RFP(6.56％,40/610)、Ofx(6.56％,40/610)、PAS(2.62％, 16/610)、Km(2.13％,13/610)、EMB(1.15％, 7/610)、Cm(0.49％,3/610)、Pto(0.16％,1/610).统计结果显示,西南地区8个监测点结核分枝杆菌临床分离株的耐多药率四川省通江县最高,为16.36％(9/55);INH耐药率四川省通江县最高,为64％(13/55);Km耐药率四川省通江县最高,为10.91％(6/55).不同年份之间结核分枝杆菌临床分离株的总耐药率[2014年为20.08％ (51/254);2015年为19.10％(68/356)]及耐多药率[2014年为4.72％(12/254);2015年为6.46％(23/356)]差异均无统计学意义(χ2=0.09,P=0.764;χ2=0.83,P=0.363).结论 中国西南地区耐药情况较为严峻,应加强该地区耐药结核病的监测.“,”Objective To investigate the drug resistance of pulmonary tuberculosis patients in southwest China through drug resistance surveillance. Methods A total of 610 Mycobacterium tuberculosis (MTB) strains isolated from smear-positive pulmonary tuberculosis patients collected from 8 national drug-resistant surveillance sites in Chongqing,Sichuan and Yunnan Provinces from 2014 to 2015 were analyzed by the drug susceptibility test (DST) of the proportion method for four first-line anti-tuberculosis drugs including Isoniazid (INH),Rifampicin (RFP), Ethambutol (EMB) and Streptomycin (Sm),as well as five second-line anti-tuberculosis drugs including Kanamycin (Km),Ofloxacin (Ofx), Capreomycin (Cm), Protionamide (Pto) and para-aminosalicylic acid (PAS). The total drug-resistance rate, mono-resistance rate,drug resistance spectrum and multi-drug resistance rate (MDR) of MTB were analyzed. The differences in drug resistance rates by different regions and years were also analyzed. Results To the nine anti-tuberculosis drugs,the overall resistance rate and MDR rate were 19.51％(119/610) and5, 74％ (35/610),respectively. Drug resistance rates ranked from high to low as INH (11.97％, 73/610), Sm (10.66％,65/610), RFP (6.56％, 40/610),Ofx (6.56％, 40/610),PAS (2.62％, 16/610), Km(2.13％, 13/610),EMB (1.15％, 7/610), Cm (0.49％, 3/610), and Pto (0.16％, 1/610). Among the 8 monitoring sites in southwest China, the statistical results showed that the highest MDR rate was 16.36％ (9/55) in Tongjiang County, Sichuan Province; the highest INH resistance rate was 23.64％ (13/55) in Tongjiang County, Sichuan Province; the highest Km resistance rate was 10.91％ (6/55) in Tongjiang County, Sichuan Province. There was no significant difference in drug resistance rate (year 2014 (20.08％,51/254); year 2015 (19.10％, 68/356)) and MDR rate (year 2014 (4.72％, 12/254); year 2015 (6.46％,23/356)) between different years (χ2=0.09,P=0.764; χ2=0.83,P=0.363). Conclusion The drug resistance in southwest China is more severe and the surveillance of drug-resistant TB should be strengthened in this area.