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目的了解本地区初治培阳肺结核患者不同时期耐药变化情况,为制定和完善结核病控制措施改进结核病防控工作提供依据。方法收集1993.1-1995.12(下称A期)和2013.1-2015.12(下称B期)前后两个时期在我院住院的痰结核分枝杆菌培养(+),并有药物敏感试验结果的初治肺结核患者501例(其中A期90例,B期411例),就其有关项目进行调查分析。结果 AB前后两个时期总耐药率分别为62.2%(56/90)和42.8%(176/411),耐两种以上药物的耐药率分别为33.3%(30/90)和15.8%(65/411),其中MDR率分别为12.2%(11/90)和4.1%(17/411);耐药顺位由高至低A期为:RFP 26.7%(24/90),INH22.2%(20/90),EMB 21.1%(19/90),Sm 18.9%(17/90),PAS 17.8%(16/90),Cm 15.6%(14/90),Am6.7%(6/90);B期为PZA 21.9%(90/411),INH 13.6%(56/411),PAS 9.5%(39/411),Pto 9.0%(37/411),RFP 8.0%(33/411),Lfx 6.3%(26/411),Cm 1.9%(8/411),Am 1.7%(7/411)。AB前后两个时期相比,不论总耐药率(X~2=11.8,P<0.01),还是耐多药率(X~2=7.57,P<0.01)以及耐各药的任何耐药率(INH X~2=4.24,P<0.05,RFP X~2=25.44,P<0.01,EMB X~2=17.76,P<0.01,PAS X~2=5.19,P<0.05,Am X~2=5.37,P<0.05,Cm X~2=29.41,P<0.01)均为明显下降。结论本地区结核病控制工作与以往相比有较大进步,但当前结核耐药性在全国仍处于较高水平,应预继续努力,加强耐药监测,不断采取措施,提高防控水平,减少耐药结核病,降低结核病疫情。
Objective To understand the changes of drug resistance in different periods of newly-treated positive pulmonary tuberculosis patients in this area and provide the basis for developing and perfecting the control measures of tuberculosis and improving the prevention and control of tuberculosis. Methods The clinical data of sputum Mycobacterium tuberculosis (+) hospitalized in our hospital from January 1993 to January 1995 (hereinafter referred to as Phase A) and the period from January 2013 to December 2015 (hereinafter referred to as Phase B) were collected, and the results of drug-sensitive test for newly diagnosed tuberculosis 501 patients (including 90 cases of A, 411 cases of B), the relevant items for investigation and analysis. Results The overall rates of resistance in the two periods before and after AB were 62.2% (56/90) and 42.8% (176/411), respectively. The resistance rates to two or more drugs were 33.3% (30/90) and 15.8% 65/411). The rates of MDR were 12.2% (11/90) and 4.1% (17/411), respectively. The high-to-low drug resistance A phase were RFP 26.7% (24/90), INH22.2 (20/90), EMB 21.1% (19/90), Sm 18.9% (17/90), PAS 17.8% (16/90), Cm 15.6% (14/90), Am 6.7% 90), 13.6% (56/411) of INH, 9.5% (39/411) of PAS, 9.0% (37/411) of Pto and 8.0% of RFP (33/411) , Lfx 6.3% (26/411), Cm 1.9% (8/411), Am 1.7% (7/411). AB was significantly higher than that before and after AB (X ~ 2 = 11.8, P <0.01) and resistant rate (X ~ 2 = 7.57, P <0.01) P <0.01, PAS X ~ 2 = 5.19, P <0.05, Am X ~ 2 = 4.24 P <0.05 RFP X ~ 2 = 25.44 P <0.01 EMB X 2 = 17.76 P < 5.37, P <0.05, Cm X ~ 2 = 29.41, P <0.01). Conclusion TB control work in this area has made great progress compared with the past. However, the current TB drug resistance in China is still at a high level throughout the country. Pre-continuous efforts should be made to strengthen drug resistance surveillance and continue to take measures to improve prevention and control and reduce resistance Drug TB, reduce the tuberculosis epidemic.