2018—2023年济宁市结核分枝杆菌耐药情况分析

doi:10.20199/j.issn.1672-2302.2024.04.008

摘要/Abstract

摘要：

目的了解济宁市结核分枝杆菌耐药情况，为结核病的临床合理用药和化疗方案制定提供参考。方法 2018—2023年济宁市公共卫生医疗中心结核病患者的痰液、灌洗液等标本进行培养，对结果为结核分枝杆菌复合群阳性的分离株进行表型药物敏感性试验，分析其对抗结核药物利福平（rifampin, RFP）、异烟肼（isonniazid, INH）、乙胺丁醇（ethambutol, EMB）、链霉素（streptomycin, Sm）、阿米卡星（amikacin, Am）、卡那霉素（kanamycin, Km）、左氧氟沙星（levofloxacin, LFX）的耐药性。结果共收集3 348株结核分枝杆菌分离株，总耐药率为23.33%（781/3 348），其中单耐药率为13.02%（436/3 348），多耐药率为6.69%（224/3 348），耐多药率为3.61%（121/3 348），广泛耐药前期耐药率为1.31%（44/3 348），广泛耐药率为0.53%（18/3 348）。耐药人群以男性（72.60%，567/781）、农民（76.70%，599/781）为主，年龄以20~39岁居多（35.21%，275/781）。2018—2023年结核分枝杆菌分离株的总耐药率、单耐药率、多耐药率、耐多药率、广泛耐药率未见趋势性变化（P均>0.05）；广泛耐药前期耐药率呈波动上升趋势（P<0.05）。单一耐药率前3位是Sm（18.91%，633/3 348）、INH（13.59%，455/3 348）和LFX（10.27%，344/3 348）。耐药谱构成方面，单耐药以耐INH（13.19%，103/781）、Sm（38.03%，297/781）最多；多耐药以INH+Sm联合耐药最多（25.10%，196/781）；耐多药以RFP+INH+Sm（6.66%，52/781）、RFP+INH+EMB+Sm（6.91%，54/781）两种联合耐药形式最多；广泛耐药前期以RFP+INH+EMB+Sm+LFX联合耐药最多（2.18%，17/781）；广泛耐药以RFP+INH+EMB+Sm+LFX+Km+Am联合耐药最多（0.90%，7/781）。结论济宁市结核分枝杆菌耐药率仍处于较高的水平，耐药防控形势不容乐观。应进一步加强临床抗结核药物的使用规范，减少耐药情况的发生。

关键词: 结核分枝杆菌, 抗结核药物, 耐药, 济宁市

Abstract:

Objective To analyze the drug resistance of Mycobacterium tuberculosis in Jining area for scientific evidences to develop rational medication regimen in clinic for tuberculosis. Methods Sputum and lavage fluid as well as other samples were harvested from TB patients in Jining Public Health Medical Center from 2018 to 2023. All samples were cultured, and phenotypic drug sensitivity test was conducted on the isolates with positive results of Mycobacterium tuberculosis complex. The drug resistance against rifampin (RFP), isoniazid (INH), ethambutol (EMB), streptomycin (Sm), amikacin (Am), kanamycin (Km), and levofloxacin (LFX), together with the demographic characteristics of drug-resistant patients, was analyzed. Results In total, 3 348 isolates of Mycobacterium tuberculosis were obtained, with a total drug resistance rate of 23.33% (781/3 348). The single drug resistance rate, rate of multidrug resistance, poly resistance rate, pre extensive drug resistance rate and extensive drug resistance rate were 13.02% (436/3 348), 6.69% (224/3 348), 3.61% (121/3 348), 1.31% (44/3 348), and 0.53% (18/3 348), respectively. The drug-resistance was most seen in males (72.60%, 567/781), farmers (76.70%, 599/781), and patients aged between 20 and 39 years (35.21%, 275/781). There was no significant change in the overall drug resistance rate, single drug resistance rate, rate of multi-drug resistance, poly resistance rate and extensive multi drug resistance rate of Mycobacterium tuberculosis isolates from 2018 to 2023 (all P>0.05). The resistance rate prior to occurrence of extensive drug resistance showed a fluctuating upward trend (P<0.05). The top three single drug resistance rates were Sm (18.91%, 633/3 348), INH (13.59%, 455/3 348) and LFX (10.27%, 344/3 348). In terms of the composition of drug resistance spectrum, single drug resistance was dominated by INH (13.19%, 103/781) and Sm (38.03%, 297/781), and the combination of INH+Sm showed the highest multidrug resistance (25.10%, 196/781). Combined multidrug resistance was dominated respectively by RFP+INH+Sm (6.66%, 52/781) and RFP+INH+EMB+Sm (6.91%, 54/781). Extensive drug resistance occurred most in the early stage was associated with combination of RFP+INH+EMB+Sm+LFX (2.18%, 17/781) and RFP+INH+EMB+Sm+LFX+Km+Am (0.90%, 7/781). Conclusion The drug resistance rate of Mycobacterium tuberculosis in Jining area still remains at a higher level, and there is no room for optimism in prevention and control of drug resistance in this area, for which standardized use of anti-tuberculosis drugs in clinic should be further strengthened in order to reduce the incidence of drug resistance.

Key words: Mycobacterium tuberculosis, Anti-tuberculosis drugs, Drug resistance, Jining City

中图分类号:

R181.3，R52

吴雯晶, 吴佗, 胡婧, 李晓华, 柴海燕. 2018—2023年济宁市结核分枝杆菌耐药情况分析[J]. 热带病与寄生虫学, 2024, 22(4): 227-232.

WU Wenjing, WU Tuo, HU Jing, LI Xiaohua, CHAI Haiyan. Drug resistance analysis of Mycobacterium tuberculosis isolates in Jining from 2018 to 2023[J]. Journal of Tropical Diseases and Parasitology, 2024, 22(4): 227-232.

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年份	分离菌株数	总耐药		单耐药		多耐药		耐多药		广泛耐药前期		广泛耐药
年份	分离菌株数	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）
2018	567	129	22.75	82	14.46	30	5.29	17	3.00	2	0.35	2	0.35
2019	592	130	21.96	82	13.85	31	5.24	17	2.87	5	0.84	1	0.17
2020	510	126	24.71	62	12.16	47	9.22	17	3.33	7	1.37	4	0.78
2021	614	163	26.55	73	11.89	63	10.26	27	4.4	13	2.12	3	0.49
2022	448	104	23.21	55	12.28	28	6.25	21	4.69	9	2.01	5	1.12
2023	617	129	20.91	82	13.29	25	4.05	22	3.57	8	1.30	3	0.49
合计	3 348	781	23.33	436	13.02	224	6.69	121	3.61	44	1.31	18	0.54

特征	耐药患者数（例）	耐药构成比（%）
性别
男	567	72.60
女	214	27.40
年龄（岁）
0~19	44	5.63
20~39	275	35.21
40~59	201	25.74
≥ 60	261	33.42
职业
农民	599	76.70
工人	39	4.99
学生	45	5.76
其他	98	12.55

药物	2018年		2019年		2020年		2021年		2022年		2023年		总耐药数（株）	总耐药率（%）
药物	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	耐药数（株）	耐药率（%）	总耐药数（株）	总耐药率（%）
RFP	30	5.29	38	6.42	22	4.31	31	5.05	26	5.80	33	5.35	180	5.38
INH	59	10.41	79	13.34	83	16.27	95	15.47	70	15.63	69	11.83	455	13.59
EMB	18	3.17	12	2.03	28	5.49	17	2.77	16	3.57	7	1.13	98	2.93
Sm	103	18.17	101	17.06	104	20.39	152	24.76	73	16.29	100	16.21	633	18.91
Km	11	1.94	16	2.70	8	1.57	19	3.09	6	1.34	16	2.59	76	2.27
Am	5	0.88	8	1.35	10	1.96	10	1.63	7	1.56	12	1.94	52	1.55
LFX	54	9.52	67	11.32	42	8.24	71	11.56	70	15.63	40	6.48	344	10.27