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目的分析重庆地区耐多药结核病患者抗结核药物的特征,预期为临床药物的选择和耐多药结核病防治规划的完善提供科学依据。方法连续收集重庆市公共卫生医疗救治中心和重庆市第十二人民医院结核内科2013年7月16日至2015年3月11日期间753例临床诊断为耐多药结核病患者的体液标本,采用液体培养法分离培养分枝杆菌,对结核分枝杆菌分离株进行比例法药物敏感性试验,并与全国2007-2008年结核病耐药基线调查结果相比较。采用SPSS 13.0分析软件进行统计学分析,卡方检验以P<0.05为差异具有统计学意义。结果 1.共分离培养出538例分枝杆菌菌株,经鉴定确认结核分枝杆菌有503例,占95.8%(503/538),非结核分枝杆菌有35例。2.503例耐多药结核患者菌株药物敏感性试验结果显示:MDR有428例,XDR有75例。仅对INH和RFP耐药的菌株有34例,仅对一线抗结核药物耐药的菌株有61例,且两种耐药谱在初治与复治分类有显著差异(P值均<0.05)。初治与复治耐多药结核患者在“31-40”和“41-50”年龄组人数分布有显著差异(P<0.05)。EMB耐药率远低于全国2007-2008年结核病耐药基线调查结果。结论重庆地区大部分耐多药结核患者对多数二线抗结核药物耐药,要加强防控,以免进一步发展为广泛耐药患者。对31-50岁左右的初治耐多药结核患者选择用药方案需慎重,以免初治失败。EMB耐药率较低,在重庆地区用于治疗培阳耐多药结核仍有很大的临床抗结核价值,但需予以关注,谨防产生耐药。
Objective To analyze the characteristics of anti-tuberculosis drugs in patients with multidrug-resistant tuberculosis in Chongqing and to provide scientific basis for the selection of clinical drugs and the improvement of multidrug - resistant tuberculosis prevention and control programs. Methods A total of 753 specimens of patients with MDR-TB were randomly collected from Chongqing Public Health Medical Center and Chongqing Twelfth People’s Hospital for Tuberculosis from July 16, 2013 to March 11, 2015. Liquid samples Mycobacterium was isolated and cultured by culture method, and the drug susceptibility test of Mycobacterium tuberculosis isolates by proportional method was compared with the national baseline survey of tuberculosis drug resistance in 2007-2008. Using SPSS 13.0 analysis software for statistical analysis, chi-square test with P <0.05 was considered statistically significant. 538 mycobacteria strains were isolated and cultured. There were 503 cases of Mycobacterium tuberculosis identified, accounting for 95.8% (503/538), and 35 cases of non-tuberculous mycobacteria. 2.503 MDR-TB patients drug susceptibility test results showed that: 428 cases of MDR, XDR in 75 cases. There were 34 isolates resistant to INH and RFP alone, 61 isolates resistant only to first-line anti-TB drugs, and there was a significant difference in the two drug resistance spectrum between primary and retreatment (P <0.05) . There was a significant difference (P <0.05) in the distribution of the number of newly diagnosed and retreated MDR-TB patients in the “31-40” and “41-50” age groups. EMB resistance rate is much lower than the national baseline survey of tuberculosis drug resistance 2007-2008. Conclusion Most MDR-TB patients in Chongqing are resistant to the majority of second-line anti-tuberculosis drugs, so they should be strengthened to prevent and control further development so as to avoid further development of patients with extensive drug resistance. Early treatment of 31-50-year-old multidrug-resistant tuberculosis patients should choose the medication program carefully, so as to avoid initial treatment failure. EMB low rate of resistance in the area of Chongqing for the treatment of multidrug-resistant tuberculosis TB still have great clinical value of anti-TB, but need to be concerned about, beware of drug resistance.