摘要
目的:了解浙江北部结核分枝杆菌(Mycobacterium tuberculosis, MTB)耐药情况,为临床结核病治疗及该地区结核病防控提供依据。方法:选取2018~2022年杭州市结核病定点医院(杭州师范大学附属医院)收治的2539例肺结核患者作为研究对象,采集肺结核患者的性别、年龄及对异烟肼(INH)利福平(RIF)、链霉素(SM)、乙胺丁醇(EMB)一线抗结核药物和对氧氟沙星(OFX)、卡那霉素(Km)、卷曲霉素(Cm)、丁胺卡那霉素(Am)、丙硫异烟胺(PTO)、对氨基水杨酸(PAS)二线抗结核药物的耐药情况等临床资料进行数据整理,使用SPSS26.0统计软件进行χ2检验,以P INH > SM > EMB;二线抗结核药物耐药顺序:OFX > Am > Cm > PTO > Km = PAS;肺结核初治和复治患者总耐药率分别为6.10%、14.67%,耐多药率分别为2.41%、6.56%,差异均具有统计学意义(P 0.05);2018~2022年总耐药率分别为6.57%、7.45%、8.60%、6.26%、6.07%,差异无统计学意义;20~40岁年龄段结核患病人数及耐药率最高;2020~2022年广泛耐药占总耐药比例分别为2.56%、9.09%、10.34%,呈递增趋势。结论:浙江省北部结核分枝杆菌总耐药率、耐多药率均低于全国平均水平,但复治肺结核患者总耐药率和耐多药率较初治显著升高,需进一步研究耐药病例合理的化疗方案,重点加强对结核病初、复治患者的治疗管理,从源头上减少结核耐药的发生。
Objective: To understand the drug-resistant status of Mycobacterium tuberculosis (MTB) in north-ern Zhejiang, and to provide a basis for clinical tuberculosis treatment and tuberculosis prevention and control in this region. Methods: 2539 pulmonary tuberculosis patients admitted to the desig-nated tuberculosis hospital in Hangzhou (Affiliated Hospital of Hangzhou Normal University) from 2018 to 2022 were selected as the research subjects. The gender, age, and response to isoniazid (INH), rifampicin (RIF), Mycomycin (SM), ethambutol (EMB) first-line anti-tuberculosis drugs and ofloxacin (OFX), kanamycin (Km), capreomycin (Cm), amikacin (Am), prothionamide (PTO), and pa-ra-aminosalicylic acid (PAS) second-line anti-tuberculosis drugs resistance status and other clinical data were compiled, and SPSS26.0 statistical software was used to conduct χ2 test, with P INH > SM > EMB;the order of second-line anti-tuberculosis drug resistance: OFX > Am > Cm > PTO > Km = PAS;the total drug resistance rates of the first treatment and the retreatment of pulmonary tuberculosis pa-tients were 6.10%, 14.67%, 2.41% and 6.56%, respectively, the difference was statistically signifi-cant (P 0.05);the total drug resistance rates from 2018 to 2022 were 6.57%, 7.45%, 8.60%, 6.26% and 6.07%, respectively. There was no significant difference. The 20~40 age group has the highest tu-berculosis prevalence and drug resistance rate;from 2020 to 2022, the proportion of extensive drug resistance to total drug resistance was 2.56%, 9.09% and 10.34%, respectively, showing an increasing trend. Conclusions: The total drug resistance rate and multidrug resistance rate of My-cobacterium tuberculosis in northern Zhejiang Province are lower than the national average, but the total drug resistance rate and multidrug resistance rate of retreated tuberculosis patients are sig-nificantly higher compared with those of primary treatment, which calls for further research on ra-tional chemotherapy regimens for drug-resistant cases, focus on strengthening treatment man-agement for first-time and repeat tuberculosis patients, and reducing tuberculosis drug resistance at its source.
出处
《临床医学进展》
2023年第11期18499-18506,共8页
Advances in Clinical Medicine
