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目的分析江苏省连云港市肺结核患者结核分枝杆菌耐药状况,为今后制定结核病预防控制策略提供依据。方法连续纳入2011年1—9月连云港市各区(县)疾病预防控制中心或结核病定点医院确诊的痰涂片阳性肺结核患者522例,其中初治患者396例,复治患者126例。连云港市第四人民医院实验室采用简单法对所有纳入的522例肺结核患者标本进行结核分枝杆菌固体培养和比例法药物敏感性试验。结果培养阳性的479株结核分枝杆菌中,任意耐药的菌株为151株(31.5%),其中初治患者和复治患者任意耐药率分别为20.9%(76/363)和64.7%(75/116),复治患者任意耐药率显著高于初治患者(χ2=77.84,P<0.001)。此外,初治患者中单耐药率(11.6%,42/363)与复治患者(11.2%,13/116)相近,两者差异无统计学意义(χ2=0.011,P=1.000);而复治患者耐2种药物(18.1%,21/116)、3种药物(17.2%,20/116)及3种药物以上(18.1%,21/116)的率均显著高于初治患者[分别为3.6%(13/363)、1.7%(6/363)、4.1%(15/363)](χ2值分别为28.11、41.61和24.69,P值均小于0.001)。结论江苏省连云港市涂阳肺结核患者耐药疫情比较严重,复治患者为主要耐药人群。
Objective To analyze the drug resistance of Mycobacterium tuberculosis in patients with pulmonary tuberculosis in Lianyungang City, Jiangsu Province, and to provide basis for future prevention and control strategies for tuberculosis. Methods A total of 522 sputum smear positive pulmonary tuberculosis patients diagnosed in all districts and counties (districts) in Lianyungang City from January to September 2011 were included, of which 396 were untreated patients and 126 were retreatment patients. Fourth People’s Hospital of Lianyungang City Laboratory using simple method for all included in the sample of 522 patients with tuberculosis Mycobacterium tuberculosis solid culture and the proportion of drug sensitivity test. Results Among the 479 positive Mycobacterium tuberculosis strains, there were 151 resistant strains (31.5%) randomly, of which 20.9% (76/363) and 64.7% 75/116). The rate of arbitrary drug resistance in retreatment patients was significantly higher than that in the newly diagnosed patients (χ2 = 77.84, P <0.001). In addition, the single drug resistance rate (11.6%, 42/363) in newly diagnosed patients was similar to that in retreatment (11.2%, 13/116), with no significant difference (χ2 = 0.011, P = 1.000) The rates of resistance to two drugs (18.1%, 21/116), three drugs (17.2%, 20/116) and more than three drugs (18.1%, 21/116) 3.6% (13/363), 1.7% (6/363) and 4.1% (15/363), respectively) (χ2 = 28.11, 41.61 and 24.69, respectively; all P values were less than 0.001). Conclusions The drug-resistant outbreak in smear-positive pulmonary tuberculosis patients in Lianyungang City of Jiangsu Province is rather serious, and the retreatment patients are the major drug-resistant population.