2015-2017年度韶关市结核病就诊患者耐多药情况分析

郭子玉; 李德昌

doi:10.16462/j.cnki.zhjbkz.2019.04.020

2015-2017年度韶关市结核病就诊患者耐多药情况分析

doi: 10.16462/j.cnki.zhjbkz.2019.04.020

郭子玉¹,
李德昌^2, ,

1.
512028 韶关, 粤北第二人民医院结控科
2.
512028 韶关, 粤北第二人民医院院办

详细信息

通讯作者:
李德昌, E-mail: LidechangSG@sina.com

中图分类号: R521.9
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- 被引次数: 0
出版历程
- 收稿日期: 2018-08-24
- 修回日期: 2018-12-18
- 刊出日期: 2019-04-10

Analysis of multi drug resistance status of tuberculosis patients in Shaoguan from 2015 to 2017

GUO Zi-yu¹,
LI De-chang^{2
, ,}

1.
Department of Tuberculosis Control, Second People's Hospital of Yuebei, Shaoguan 512028, China
2.
Hospital officell, Second People's Hospital of Yuebei, Shaoguan 512028, China

More Information

Corresponding author: Li De-chang, E-mail: LidechangSG@sina.com

摘要

摘要: 目的探析位于粤北山区的韶关市2015-2017年度耐多药肺结核患者（multi drug resistant pulmonary tuberculosis，MDR-TB）的筛查情况。方法回顾性分析562例可疑MDR-TB患者及新患者的临床资料，所有患者均接受了传统药敏试验，统计异烟肼（isonicotinyl hydrazide，INH）、利福平（rifampicin，RFP）、乙胺丁醇（Ethambutol，EMB）、链霉素（streptomycin，SM）、氧氟沙星（ofloxacin，Ofx）、卡那霉素（kanamycin，Km）耐药情况及MDR-TB筛查结果。结果传统药敏试验结果中，SM的耐药率最高，达19.22%（108/562），KM的耐药率最低，为4.45%（25/562）。562例患者的传统确诊结果显示，MDR-TB检出率为6.94%（39/562）。MDR-TB检出率在性别、年龄、文化程度、地区之间均无统计学意义（均有P>0.05）；不同患者类型的MDR-TB检出率之间有统计学意义（P < 0.001）。结论肺结核患者耐药率顺位依次为链霉素、异烟肼、利福平、乙胺丁醇、氧氟沙星和卡那霉素。复治组患者的单耐药率、耐多药率均高于初治组。应以复治患者为重点，扩大筛查范围，及时治愈初治患者。
- 耐多药肺结核 /
- 筛查 /
- 药敏试验 /
- 初治 /
- 复治
Abstract: Objective To investigate the screening status of multi drug resistant pulmonary tuberculosis(MDR-TB) in 2015-2017. Methods The clinical data of 562 patients with suspected MDR-TB were retrospectively analyzed. All patients received traditional drug susceptibility tests. The data of isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (SM), ofxofloxacin (Ofx), kanamycin (Km) resistance and MDR-TB screening results were analyzed. Results Results of traditional drug susceptibility test showed that SM had the highest drug resistance rate[19.22% (108/562)] and KM had the lowest resistance rate[4.45% (25/562)]. Traditional diagnosis of 562 patients showed that the detection rate of MDR-TB was 6.94% (39/562). There was no statistically significant difference in the detection rate of MDR-TB between different sex, age, education level. The detection rate of MDR-TB was not statistically significant between different gender, age, education level and region (all P>0.05).There was significantly different in the detection rate of MDR-TB between different patient types (P < 0.001). Conclusions The drug resistance rate of pulmonary tuberculosis patients was followed by streptomycin, isoniazid, rifampicin, ethambutol, ofloxacin and kanamycin. The single drug resistance rate and multidrug resistance rate of the patients in the retreatment group were higher than those in the initial treatment group. With the focus on the retreatment of patients, expand the scope of screening, timely cure the initial treatment of patients.
- Multidrug-resistant tuberculosis /
- Screening /
- Susceptibility testing /
- Initial treatment /
- Retreatment

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表 1 562例患者的传统药敏试验结果[n(%)]

Table 1. Analysis of the results of traditional drug sensitivity test in 562 patients [n(%)]

耐药情况	传统-INH	传统-RFP	传统-EMB	传统-SM	传统-OFx	传统-Km
敏感	477(84.88)	512(91.10)	514(91.46)	454(80.78)	522(92.88)	537(95.55)
耐药	85(15.12)	50(8.90)	48(8.54)	108(19.22)	40(7.12)	25(4.45)

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表 2 562例患者的MDR-TB的传统确诊结果

Table 2. Analysis of the traditional diagnosis results of MDR-TB in 562 patients

确诊结果	例数(例)	百分率(%)
非耐药患者	403	71.71
MDR^a(耐R^b、H^c)	28	4.98
XDR^d (耐R、H、Ofx^e、Km^f)	11	1.96
耐H不耐R	46	8.19
耐R不耐H	11	1.96
其他DR^g(R、H都不耐)	63	11.21
注：^aMDR: multidrug-resistant，耐多药；^bR: rifampicin，利福平；^cH: isoniazid，异烟肼；^dXDR: extremely drug-resistant，广泛；^eOfx: ofloxacin，氧氟沙星；^fKm: kanamycin，卡那霉素；^gDR: drug-resistant，耐药。R：利福平；H：异烟肼

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表 3 MDR-TB患者的筛查结果[n(%)]

Table 3. Analysis of screening results of MDR-TB patients [n(%)]

因素	例数(例)	MDR-TB检出率	χ²值	P值
性别			1.501	0. 31
男	464	35(7.54)
女	98	4(4.08)
年龄(岁)			0.709	0. 45
＜20	9	0
20~	94	7(5.22)
＞40	459	32(6.97)
文化程度			2.686	0. 35
初中及以下	465	36(7.74)
高中及以上	97	3(3.09)
地区			0.09	0. 47
城镇	199	14(7.57)
农村	363	25(6.89)
患者类型			34.62	＜0.001
初治患者	403	12(2.98)
复治患者	159	27(16.98)

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表 4 患者类型与患者来源间MDR-TB检出与耐药种类分析[n(%)]

Table 4. MDR-TB detection and drug resistance type analysis between patient type and patient source[n(%)]

类别	例数(n)	MDR-TB	INH	RFP	EMB	SM	OFx	Km
患者来源
门诊患者	307	14(4.56)	33(10.75)	19(6.19)	15(4.89)	55(17.92)	20(6.51)	12(3.91)
住院患者	255	25(9.80)	52(20.39)	31(12.16)	33(12.94)	53(20.78)	20(7.84)	13(5.10)
χ²值		5.931	10.090	6.121	11.571	0.739	0.372	0.463
P值		0.015	0.002	0.013	0.001	0.390	0.542	0.496
患者类型
初治患者	403	12(2.98)	42(10.42)	17(4.22)	21(5.21)	67(16.63)	22(5.46)	13(3.23)
复治患者	159	27(16.98)	43(27.04)	33(20.76)	27(16.98)	41(25.79)	18(11.32)	12(7.55)
χ²值		34.620	24.540	38.470	20.220	6.160	5.930	5.010
P值		＜0.001	＜0.001	＜0.001	＜0.001	0.042	＜0.001	0.050

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