618例耐多药结核病患者流行病学特征研究

doi:10.19983/j.issn.2096-8493.20253076

摘要/Abstract

摘要： 目的: 分析618例耐多药结核病患者的流行病学特征以及相关的风险因素,探讨耐多药结核病的防治策略。方法: 收集2018年1月至2022年12月在南宁市第四人民医院住院治疗的618例耐多药结核病患者的诊疗信息,分析其临床、检验的特点,并对耐多药结核病发病的性别、年龄、职业、合并症、耐药性等方面进行研究。基质辅助激光解吸电离飞行时间质谱对分枝杆菌菌种进行鉴定,分枝杆菌药敏试验（MIC法）鉴定结核分枝杆菌的耐药表型,PCR-线性杂交酶显色法或者荧光PCR熔解曲线法对结核分枝杆菌复合群进行利福平和异烟肼耐药基因的分子生物学检测。结果: 从618例患者的标本中,分离到的1078株耐多药结核分枝杆菌。152例为继发性耐多药结核病患者,结核分枝杆菌对异烟肼的耐药率超过了利福平,诱导结核分枝杆菌对异烟肼产生耐药性所需要的时间明显短于对利福平的诱导时间。抗结核治疗依从性差是导致继发性耐药结核病发生的主要原因,耐多药结核病好发于老年男性和年轻女性。糖尿病和乙型病毒性肝炎在男性耐多药结核病患者中,具有较高的发病率。katG315和rpoB529~533是结核分枝杆菌最常见的耐药突变位点。结论: 耐多药结核分枝杆菌的传播在耐多药结核病发病和流行中起到重要作用。预防耐多药结核病的播散,需要加强对结核病的防治工作。

关键词: 结核, 抗药性, 多药, 流行病学, 基因, 危险因素

中图分类号:

R521

闭德武, 罗晓成, 何华伟, 罗晓璐. 618例耐多药结核病患者流行病学特征研究[J]. 结核与肺部疾病杂志, 2025, 6(S1): 47-51. doi: 10.19983/j.issn.2096-8493.20253076

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