甘肃省2941株结核分枝杆菌临床分离株耐药情况分析

doi:10.19983/j.issn.2096-8493.20250061

摘要/Abstract

摘要：

目的: 分析甘肃省传染病医院2022—2024年结核分枝杆菌(Mycobacterium tuberculosis,MTB)临床分离株的耐药情况,为甘肃省耐药结核病的精准防控、治疗提供科学依据。方法: 选取甘肃省传染病医院2022—2024年从痰液或者肺泡灌洗液中培养鉴定的2941株MTB临床分离株,收集菌株对9种抗结核药物[包括异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、左氧氟沙星(Lfx)、丙硫异烟胺(Pto)、对氨基水杨酸钠(PAS)、莫西沙星(Mfx)、卷曲霉素(Cm)、阿米卡星(Am)]的药物敏感性试验(简称“药敏试验”)结果并进行分析。结果: 2941株MTB中敏感株占62.39%(1835/2941),耐药株占37.61%(1106/2941)。菌株的单耐药率为7.14%(210/2941),多耐药率为12.58%(370/2941),耐多药率为11.39%(335/2941),广泛耐药率为6.49%(191/2941)。9种抗结核药物的耐药顺位依次为:INH(28.66%,843/2941)、RFP(20.50%,603/2941)、Lfx(10.34%,304/2941)、Mfx(9.49%,279/2941)、EMB(8.06%,237/2941)、PAS(1.73%,51/2941)、Pto(1.67%,49/2941)、Cm(0.92%,27/2941)、Am(0.78%,23/2941)。耐药谱共计71种,包括单耐药谱8种,多耐药谱26种,耐多药谱15种,广泛耐药谱22种。结论: 甘肃省传染病医院肺结核患者MTB临床分离株耐药率较高,以多耐药和耐多药为主,耐药谱呈现复杂性和多样性,应重视肺结核患者的耐药筛查,强化耐药患者的监测。

关键词: 分枝杆菌, 结核, 抗药性, 微生物敏感性试验

Abstract:

Objective: To analyze the drug resistance of clinical isolates of Mycobacterium tuberculosis (MTB) in Gansu Provincial Infectious Diseases Hospital from 2022 to 2024, so as to provide scientific basis for precise prevention, control and treatment of drug-resistant tuberculosis in Gansu Province. Methods: A total of 2941 clinical isolates of MTB cultured and identified from sputum or bronchoalveolar lavage fluid in Gansu Provincial Infectious Disease Hospital from 2022 to 2024 were selected. The results of drug sensitivity tests on 9 anti-tuberculosis drugs, including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), levofloxacin (Lfx), propiconazole (Pto), sodium aminosalicylate (PAS), moxifloxacin (Mfx), capreomycin (Cm), and amikacin (Am), were collected and analyzed. Results: Among 2941 clinical isolates of MTB, drug sensitive strains accounted for 62.39% (1835/2941) and drug-resistant strains accounted for 37.61% (1106/2941). The single drug resistance rate of the strain was 7.14% (210/2941), the poly-drug resistance rate was 12.58% (370/2941), the multi-drug resistance rate was 11.39% (335/2941), and the extensive-drug resistance rate was 6.49% (191/2941). The resistance sequence of the 9 anti-tuberculosis drugs as follows: INH (28.66%, 843/2941), RFP (20.50%, 603/2941), Lfx (10.34%, 304/2941), Mfx (9.49%, 279/2941), EMB (8.06%, 237/2941), PAS (1.73%, 51/2941), Pto (1.67%, 49/2941), Cm (0.92%, 27/2941), Am (0.78%, 23/2941). There were a total of 71 drug resistance spectra, including 8 single drug resistance spectra, 26 poly-drug resistance spectra, 15 multi-drug resistance spectra, and 22 extensive-drug resistance spectra. Conclusion: The clinical isolates of MTB from tuberculosis patients in Gansu Provincial Infectious Diseases Hospital have a high resistance rate, mainly poly-drug resistance and multi-drug resistance. The resistance spectrum presents complexity and diversity, and drug resistance screening of tuberculosis patients should be emphasized, and monitoring of drug-resistant patients should be strengthened.

Key words: Mycobacterium tuberculosis, Drug resistance, Microbial sensitivity tests

中图分类号:

魏黛珏, 孙建军, 陈彦, 王世军, 常亚梅, 魏念欢, 张鑫, 同重湘. 甘肃省2941株结核分枝杆菌临床分离株耐药情况分析[J]. 结核与肺部疾病杂志, 2025, 6(4): 444-448. doi: 10.19983/j.issn.2096-8493.20250061

Wei Daijue, Sun Jianjun, Chen Yan, Wang Shijun, Chang Yamei, Wei Nianhuan, Zhang Xin, Tong Chongxiang. Analysis of drug resistance of 2941 clinical isolates of Mycobacterium tuberculosis in Gansu Province[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(4): 444-448. doi: 10.19983/j.issn.2096-8493.20250061

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特征	初治组(2085例)			复治组(856例)			合计(2941例)			χ²值	P值
特征	例数	耐药例数	耐药率 (%)	例数	耐药例数	耐药率 (%)	例数	耐药例数	耐药率 (%)	χ²值	P值
性别										20.691	<0.001
男性	1091	243	22.27	573	442	77.14	1664	685	41.17
女性	994	220	22.13	283	201	71.02	1277	421	32.97
年龄组(岁)										28.574	<0.001
≤20	174	41	23.56	18	9	50.00	192	50	26.04
21~39	510	96	18.82	252	204	80.95	762	300	39.37
40~59	543	123	22.65	318	248	77.99	861	371	43.09
≥60	858	203	23.66	268	182	67.91	1126	385	34.19

特征	初治组(2085株)		复治组(856株)		合计(2941株)		χ²值	P值
特征	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	χ²值	P值
单耐药	170	8.15	40	4.67	210	7.14	11.091	0.001
多耐药	214	10.26	156	18.22	370	12.58	34.965	<0.001
耐多药	64	3.07	271	31.66	335	11.39	491.434	<0.001
广泛耐药	15	0.72	176	20.56	191	6.49	393.408	<0.001
合计	463	22.21	643	75.12	1106	37.61	724.054	<0.001

药品	初治组(2085株)		复治组(856株)		合计(2941株)		χ²值	P值
药品	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	χ²值	P值
异烟肼	264	12.66	579	67.64	843	28.66	897.067	<0.001
利福平	121	5.80	482	56.31	603	20.50	949.693	<0.001
左氧氟沙星	91	4.36	213	24.88	304	10.34	275.671	<0.001
莫西沙星	84	4.03	195	22.78	279	9.49	248.514	<0.001
乙胺丁醇	32	1.53	205	23.95	237	8.06	411.483	<0.001
对氨基水杨酸钠	14	0.67	37	4.32	51	1.73	47.469	<0.001
丙硫异烟胺	12	0.58	37	4.32	49	1.67	52.001	<0.001
卷曲霉素	12	0.58	15	1.75	27	0.92	9.243	0.002
阿米卡星	7	0.34	16	1.87	23	0.78	18.387	<0.001

药品	初治组(2085株)		复治组(856株)		合计(2941株)		χ²值	P值
药品	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	菌株数(株)	耐药率(%)	χ²值	P值
异烟肼	60	2.88	22	2.57	82	2.79	13.761	<0.001
利福平	17	0.82	6	0.70	23	0.78	18.365	<0.001
左氧氟沙星	7	0.34	3	0.35	10	0.34	5.003	<0.001
莫西沙星	3	0.14	1	22.78	4	0.14	4.636	<0.001
乙胺丁醇	2	0.10	1	23.95	3	0.10	10.462	<0.001
对氨基水杨酸钠	1	0.05	0	0.00	1	0.03	2.128	0.034
丙硫异烟胺	3	0.14	1	4.32	4	0.14	2.527	0.012
卷曲霉素	3	0.14	0	0.00	3	0.10	2.051	0.043
阿米卡星	0	0.00	0	0.00	0	0.00	-	-