论文部分内容阅读
目的:分析江苏省结核分枝杆菌耐药谱及耐药结核病的危险因素,为制定结核病预防和控制策略提供科学依据。方法:收集2010年6～7月新登记报告的痰涂阳性的结核病患者痰标本,并经痰涂片检测和痰培养证实。运用WHO/IUATLD推荐的比例法药敏试验测定结核分枝杆菌分离株对4种常用一线抗结核药的敏感性,进行耐药谱分析,并探讨耐药结核病产生的影响因素。结果:收集260株结核分枝杆菌,216株(83.1%)分离自初治患者;44株(16.9%)分离自复治患者。186株(71.5%)对利福平、异烟肼、乙胺丁醇、链霉素4种抗结核病药全敏感;74株(28.5%)对一种或一种以上药物耐药,33株(12.7%)为单耐药菌株,34株(13.1%)同时对异烟肼和利福平耐受,为耐多药菌株,17株(6.5%)对4种一线药全耐受。多因素Logistic回归显示,抗结核治疗史与耐多药发生风险的关联有统计学意义,与初治患者相比,复治患者耐多药发生的风险增加,调整比值比(odds ratio,OR)=3.40(95%CI:1.42～8.13)。结论:江苏省结核病耐药形势严峻,需加强对初治患者的管理,切实贯彻直接面视下短程化疗策略(direct observed therapy short course,DOTS),提高结核病患者的治疗依从性和治疗成功率,减少耐药结核发生。
Objective: To analyze the drug resistance spectrum of Mycobacterium tuberculosis and the risk factors of drug-resistant tuberculosis in Jiangsu Province, and to provide a scientific basis for the development of tuberculosis prevention and control strategies. Methods: Sputum samples of sputum smear positive TB patients from June to July in 2010 were collected and confirmed by sputum smear test and sputum culture. The sensitivity ratio of Mycobacterium tuberculosis isolates to four commonly used first-line anti-tuberculosis drugs was determined by proportion-method susceptibility test recommended by WHO / IUATLD, and the drug resistance spectrum was analyzed. The influencing factors of drug-resistant TB were also discussed. Results: 260 strains of Mycobacterium tuberculosis were collected, 216 (83.1%) were isolated from untreated patients and 44 (16.9%) were from retreatment patients. 186 strains (71.5%) were completely sensitive to 4 kinds of anti-TB drugs including rifampicin, isoniazid, ethambutol and streptomycin; 74 strains (28.5%) were resistant to one or more drugs and 33 (12.7%) were single-drug resistant strains, 34 (13.1%) were resistant to isoniazid and rifampicin simultaneously. They were multi-drug resistant strains and 17 (6.5%) were fully tolerated to four kinds of first-line drugs. Multivariate Logistic regression showed that the correlation between the history of antituberculosis treatment and the risk of MDR was statistically significant. Compared with the untreated patients, the risk of MDR was increased in retreatment patients, and odds ratio (OR) = 3.40 (95% CI: 1.42 ~ 8.13). Conclusion: The drug resistance of tuberculosis in Jiangsu province is very serious. It is necessary to strengthen the management of newly diagnosed patients and effectively implement the direct observed therapy short course (DOTS) to improve the treatment adherence and success rate of TB patients. Reduce drug-resistant tuberculosis.