热带病与寄生虫学

热带病与寄生虫学 ›› 2025, Vol. 23 ›› Issue (6): 358-362.doi: 10.20199/j.issn.1672-2302.2025.06.008

• 结核病防控专题 • 上一篇    下一篇

四川省肺结核患者耐药现状及影响因素分析

雷卉(), 高媛, 张书, 何璐, 王为娜, 高文凤, 何金戈, 夏岚()   

  1. 四川省疾病预防控制中心，四川成都 610041
  • 收稿日期:2025-10-31 出版日期:2025-12-20 发布日期:2026-01-23
  • 通信作者: 夏岚 E-mail:729528065@qq.com;xialan-2006@163.com
  • 作者简介:雷卉，女，硕士，主管技师，研究方向：结核病检测。E-mail: 729528065@qq.com

The current status of drug resistance and its influencing factors among pulmonary tuberculosis patients in Sichuan Province

LEI Hui(), GAO Yuan, ZHANG Shu, HE Lu, WANG Weina, GAO Wenfeng, HE Jinge, XIA Lan()   

  1. Sichuan Center for Disease Control and Prevention, Chengdu 610041, Sichuan Province, China
  • Received:2025-10-31 Online:2025-12-20 Published:2026-01-23
  • Contact: XIA Lan E-mail:729528065@qq.com;xialan-2006@163.com

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摘要：

目的 了解四川省肺结核患者对常用抗结核药物的耐药现状，为耐药结核病精准防控提供参考。方法 选取2024年1—12月四川省结核病耐药监测项目纳入的分枝杆菌培养阳性肺结核患者为研究对象，分析患者对异烟肼（INH）、利福平（RFP）、左氧氟沙星（LFX）、莫西沙星（MFX）、贝达喹啉（BDQ）和利奈唑胺（LZD）等6种常见抗结核药物的耐药类型、种类、谱系等情况，通过多因素logistic回归模型分析耐药结核病发生的相关因素。结果 研究共纳入1 388例肺结核患者，总耐药率为20.97%（291/1 388），初治患者耐药率为19.87%（253/1 273），低于复治患者的33.04%（38/115）；6种常见抗结核药物的耐药率从高到低依次为INH（11.60%，161/1 388）、LFX（9.37%，130/1 388）、MFX（9.08%，126/1 388）、RFP（5.48%，76/1 388）、BDQ（2.23%，31/1 388）、LZD（1.51%，21/1 388）；耐药谱系以LFX+MFX最为常见，耐药率达6.05%（84/1 388）。多因素logistic回归分析显示，复治（OR=1.880，95%CI：1.228~2.837）、确诊时间≥14 d（OR=1.423，95%CI：1.036~1.938）的肺结核患者发生耐药的风险更高，涂片阴性（OR=0.718，95%CI：0.549~0.936）肺结核患者发生耐药的风险更低。结论 当前四川省肺结核患者INH及氟喹诺酮类抗生素（fluoroquinolones, FQs）耐药情况相对严重，复治、确诊延误患者发生耐药的风险高。应强化对复治肺结核患者的规范管理，提升临床诊疗的及时性和准确性，从而有效控制四川省耐药肺结核的发生。

关键词: 耐药肺结核, 药敏试验, 影响因素, 四川省

Abstract:

Objective To understand the current status of drug resistance to commonly used anti-tuberculosis drugs in pulmonary tuberculosis patients in Sichuan Province for reference for following precise prevention and control of drug-resistant tuberculosis. Methods Mycobacterium culture-positive patients enrolled in the Tuberculosis Drug Resistance Surveillance Program of Sichuan Province from January to December 2024 were selected as study subjects. The types, categories, and spectra of drug resistance to six common anti-tuberculosis drugs, including isoniazid (INH), rifampicin (RFP), levofloxacin (LFX), moxifloxacin (MFX), bedaquiline (BDQ), and linezolid (LZD), were sorted out, and the factors for drug-resistant tuberculosis were analyzed by multivariate logistic regression model. Results Among 1 388 patients, the overall drug resistance rate was 20.97% (291/1 388). The drug resistance rate in newly treated patients was 19.87% (253/1 273), which was significantly lower than that of retreated patients (33.04%, 38/115). The drug resistance rates to six common anti-tuberculosis drugs, ranking from the highest to the lowest, were as follows: INH (11.60%, 161/1 388), LFX (9.37%, 130/1 388), MFX (9.08%, 126/1 388), RFP (5.48%, 76/1 388), BDQ (2.23%, 31/1 388), and LZD (1.51%, 21/1 388). The most prevalent drug resistance profile was LFX+MFX, with a resistance rate being 6.05% (84/1 388). Multivariate logistic regression analysis showed that the patients with retreatment (OR=1.880, 95%CI: 1.228-2.837) or diagnosis delay ≥14 days (OR=1.423, 95%CI: 1.036-1.938) had a significantly higher risk to develop drug resistance, whereas those with negative smears (OR=0.718, 95%CI: 0.549-0.936) had a lower risk of developing drug resistance. Conclusion At present, the drug resistance to INH and fluoroquinolones (FQs) among pulmonary tuberculosis patients in Sichuan Province was relatively serious, and the risks of developing drug resistance is higher in patients with retreatment and delayed diagnosis. The findings suggest that it is imperative to strengthen the standardized management of retreated pulmonary tuberculosis patients, improve the timeliness and accuracy of clinical diagnosis and treatment, so as to effectively control the occurrence of drug-resistant tuberculosis in Sichuan Province.

Key words: Drug-resistant pulmonary tuberculosis, Drug sensitivity test, Influencing factors, Sichuan Province

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