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目的了解上海市首次复治肺结核患者的耐药情况,为制定复治化疗方案提供科学依据。方法回顾性分析2002年1月至2004年12月上海市疾病预防控制中心登记的痰结核杆菌培养阳性的上海市首次复治肺结核病例,全部培养阳性菌株进行菌种鉴定及5种抗结核药物(异烟肼、利福平、链霉素、乙胺丁醇、对氨水杨酸钠)的耐药性测试。结果首次复治肺结核患者的总耐药率为39.6%,男、女患者的耐药率分别为38.5%和44.4%,青年组、中年组和老年组的耐药率分别为50.0%、41.6%和34.6%。标准初治失败组和标准初治复发组的总耐药率(70.0%和47.5%)、耐药≥3种的发生率(70.0%和18.3%)均显著高于非标准初治复发组(28.2%和6.4%)。标准初治失败组的耐多药率(70.0%)显著高于标准初治复发组(16.7%)和非标准初治复发组(7.3%)。非标准初治复发组中初治用药1～5个月者的耐药率(13.0%)显著低于用药≥12个月者(55.0%),初治用药≤2种的耐药率(24.4%)略低于用药≥3种者(30.8%)。结论不同复治类型的首次复治肺结核病例的耐药率因用药史不同而各异,提示现行的标准复治化疗方案对其中部分患者可能无效。
Objective To understand the drug resistance of patients with pulmonary tuberculosis in Shanghai for the first time and provide a scientific basis for the development of re-treatment and chemotherapy regimens. Methods A retrospective analysis of the first case of re-treatment of pulmonary tuberculosis in Shanghai Municipality from January 2002 to December 2004 in Shanghai Municipal Center for Disease Control and Prevention for positive culture of sputum Mycobacterium tuberculosis was performed. All positive strains were identified for culture and five anti-TB drugs Isoniazid, rifampin, streptomycin, ethambutol, sodium p-aminosalicylate). Results The total drug resistance of the first re-treatment of tuberculosis patients was 39.6%, and the resistance rates of male and female patients were 38.5% and 44.4% respectively. The drug resistance rates in young, middle-aged and elderly groups were 50.0% and 41.6% % And 34.6%. The rates of total drug resistance (70.0% and 47.5%) and resistance> 3 species (70.0% and 18.3%) in standard initial treatment group and standard initial treatment group were significantly higher than those in non-standard initial treatment group 28.2% and 6.4%). The MDR (70.0%) in the standard initial failure group was significantly higher than that in the standard initial treatment group (16.7%) and the non-standard naive group (7.3%). The drug resistance rate (13.0%) in the non-standard naive relapse group was significantly lower than that in the first 12 months (55.0%) and in the newly treated group (≤2.4) %) Slightly lower than the medication ≥ 3 kinds of people (30.8%). Conclusions The rates of resistance of the first retreatment tuberculosis cases of different retreatment types vary with the medication history, suggesting that the current standard retreatment regimens may be ineffective in some of these patients.