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目的分析合并糖尿病的耐多药肺结核(MDR-TB)患者对二线抗结核药物的耐药情况及耐药因素,为该类患者制定可靠的化疗方案提供依据。方法将2006年1月—2014年4月宜昌市定点医院住院确诊合并糖尿病的MDR-TB 107例患者,按照血糖控制值范围高低分为A(<7.0 mmol/L)、B(7~14 mmol/L)、C(>14 mmol/L)3组,对所有病例的痰标本菌株进行6种二线抗结核药物敏感性检测。结果所有病例的痰标本所分离菌株中87.9%对所检测的6种二线抗结核药物中任1种具有耐药性,其中对氨水杨酸钠(PAS)为二线抗结核单药耐药率最高,达36.4%;对每种单药的耐药率比较显示,C组明显高于A、B两组;对耐2种及2种以上药的耐药率比较,A与B组比较,差异有统计学意义(χ2=4.126,P<0.05),C与B组比较,差异有统计学意义(χ2=26.499,P<0.01),A与C组比较,差异有统计学意义(χ2=37.391,P<0.01)。A、B、C 3组中严重耐多药结核病(XDR-TB)患者所占比率分别为3.6%、16.7%及48.4%,C组明显高于A、B两组。结论合并糖尿病MDR-TB患者的血糖控制越差,血糖值越高,其分枝杆菌对二线抗结核药物耐药种数越多,耐药率越高,耐药程度越严重。
Objective To analyze the resistance to second-line anti-tuberculosis drugs in patients with multi-drug resistant pulmonary tuberculosis (MDR-TB) complicated with diabetes mellitus and the drug resistance factors, and provide the basis for establishing reliable chemotherapy regimens for these patients. Methods A total of 107 patients with MDR-TB diagnosed as diabetes in hospital of Yichang City from January 2006 to April 2014 were divided into A (<7.0 mmol / L), B (7-14 mmol / L) and C (> 14 mmol / L). Six kinds of second-line anti-TB drug sensitivity tests were performed on sputum specimens of all cases. Results 87.9% of the isolates isolated from sputum specimens of all cases were resistant to any of the 6 second-line anti-tuberculosis drugs tested, of which the highest rate of resistance to second-line anti-tuberculosis monotherapy was sodium salicylate (PAS) , Up to 36.4%; the drug resistance rate of each single drug comparison showed that C group was significantly higher than A, B two groups; resistance to two and more than two kinds of drug resistance rates, A and B group, the difference (Χ2 = 4.126, P <0.05). The difference between C and B group was statistically significant (χ2 = 26.499, P <0.01). There was significant difference between A and C group (χ2 = 37.391 , P <0.01). The proportions of patients with severe multi-drug resistant tuberculosis (XDR-TB) in groups A, B and C were 3.6%, 16.7% and 48.4%, respectively, which were significantly higher in group C than in groups A and B. Conclusions Patients with MDR-TB diabetes mellitus have worse blood glucose control and higher blood glucose levels. The more mycobacteria are resistant to second-line anti-TB drugs, the higher the drug resistance rate and the more serious drug resistance.