广西壮族自治区柳州市初治肺结核患者耐药特征分析

doi:10.19983/j.issn.2096-8493.20250085

摘要/Abstract

摘要：

目的: 分析广西壮族自治区柳州市结核分枝杆菌临床分离株对常用抗结核药物的耐药特征,为当地结核病防治及临床合理用药提供依据。方法: 采用横断面调查方法,参照入组标准收集2024年1—12月柳州市下辖柳江区、柳城县、鹿寨县、三江县、融安县和融水县各医疗机构送检的418例初治肺结核患者痰液结核分枝杆菌分离株药物敏感性试验结果,分析不同性别、年龄、地区患者结核分枝杆菌分离株对14种抗结核药物的耐药率及耐药谱差异。结果: 418株结核分枝杆菌分离株对14种抗结核药物的总耐药率为12.20%(51/418),耐多药率为0.72%(3/418);其中,耐药率前3位为异烟肼[5.74%(24/418)]、链霉素[4.55%(19/418)]和莫西沙星[2.63%(11/418)]。51株耐药菌株中,单耐药菌株占56.86%(29/51),多耐药菌株占37.26%(19/51),耐多药菌株占5.88%(3/51);其中,单耐药类型以异烟肼耐药[23.53%(12/51)]为主,多耐药类型以链霉素与异烟肼联合耐药[11.76%(6/51)]为主。40~60岁组患者耐药率[17.36%(25/144)]明显高于<40岁组[5.00%(3/60)],差异有统计学意义(χ²=8.208,P=0.004);女性患者耐多药率[2.17%(2/92)]明显高于男性[0.31%(1/326)],差异有统计学意义(χ²=4.209,P=0.040);鹿寨县耐药率最高[16.44%(12/73)],融安县最低[4.55%(2/44)],但地区间差异无统计学意义(χ²=5.832,P=0.271)。结论: 柳州市初治肺结核患者耐药率与2018—2020 年中国结核病耐药监测数据(10.8%)基本接近,但异烟肼耐药问题突出,老年人群、女性及鹿寨县患者为耐药防控重点对象与重点区域,应加强耐药监测、优化治疗方案,进一步降低耐药结核病的传播。

关键词: 分枝杆菌,结核, 结核,抗多种药物性, 流行病学研究特征(主题), 柳州市

Abstract:

Objective: To analyze the drug resistance characteristics of Mycobacterium tuberculosis (MTB) isolates in Liuzhou, Guangxi Zhuang Autonomous Region, and to provide evidence for local tuberculosis prevention and rational clinical drug use. Methods: A cross-sectional survey was conducted, 418 MTB isolates of 418 cases of primary treatment pulmonary tuberculosis meeting the inclusion criteria were collected from Liujiang District, Liucheng County, Luzhai County, Sanjiang County, Rong’an County, and Rongshui County under Liuzhou City from January to December 2024. The resistance rates and resistance profile to 14 anti-tuberculosis drugs were analyzed across patients of different genders, ages, and regions. Results: Among the 418 MTB isolates, the overall resistance rate to 14 anti-tuberculosis drugs was 12.20% (51/418), and the multi-drug resistance rate was 0.72% (3/418). The top three drugs with the highest resistance rates were isoniazid (5.74% (24/418)), streptomycin (4.55% (19/418)), and moxifloxacin (2.63% (11/418)). Among the 51 resistant strains, mono-resistant strains accounted for 56.86% (29/51), poly-resistant strains accounted for 37.26% (19/51), and multi-drug resistant strains accounted for 5.88% (3/51). Among mono-resistant strains, isoniazid resistance (23.53% (12/51)) was most common, while among poly-resistant strains, combined resistance to streptomycin and isoniazid (11.76% (6/51)) were predominant. The resistance rate in the 40-60 age group (17.36% (25/144)) was significantly higher than that in the <40 age group (5.00% (3/60)), with a statistically significant difference (χ²=8.208, P=0.004). The mult-idrug resistance rate in female patients (2.17% (2/92)) was significantly higher than that in male patients (0.31% (1/326)), with a statistically significant difference (χ²=4.209, P=0.040). Luzhai County had the highest resistance rate (16.44% (12/73)), while Rong’an County had the lowest (4.55% (2/44)), however, the regional differences were not statistically significant (χ²=5.832, P=0.271). Conclusion: The overall drug resistance rate of newly diagnosed tuberculosis patients in Liuzhou region is basically consistent with the 2018—2020 national tuberculosis drug resistance surveillance data (10.8%). However, isoniazid resistance remains a prominent issue. Elderly populations, females, and patients from Luzhai County are key targets and areas for drug resistance prevention and control. Strengthening resistance surveillance, optimizing treatment regimens, and reducing the transmission of drug-resistant tuberculosis are recommended.

Key words: Mycobacterium tuberculosis, Tuberculosis, multidrug-resistant, Epidemiologic study characteristics as topic, Liuzhou City

中图分类号:

R52
R183

蒙雪佳, 唐柳生, 董捷, 曾庆雪. 广西壮族自治区柳州市初治肺结核患者耐药特征分析[J]. 结核与肺部疾病杂志, 2025, 6(6): 717-724. doi: 10.19983/j.issn.2096-8493.20250085

Meng Xuejia, Tang Liusheng, Dong Jie, Zeng Qingxue. Analysis of drug resistance characteristics of newly diagnosed pulmonary tuberculosis patients in Liuzhou City, Guangxi Zhuang Autonomous Region[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(6): 717-724. doi: 10.19983/j.issn.2096-8493.20250085

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药物类别/ 药物名称	敏感菌株数	耐药菌株数	耐药率 (%)	药物类别/ 药物名称	敏感菌株数	耐药菌株数	耐药率 (%)
一线药物				氧氟沙星	409	9	2.15
异烟肼	394	24	5.74	左氧氟沙星	411	7	1.67
利福平	410	8	1.91	莫西沙星	407	11	2.63
链霉素	399	19	4.55	卡那霉素	417	1	0.24
乙胺丁醇	417	1	0.24	卷曲霉素	417	1	0.24
吡嗪酰胺	414	4	0.96	阿米卡星	417	1	0.24
二线药物				对氨基水杨酸	414	4	0.96
利福布汀	411	7	1.67	丙硫异烟胺	415	3	0.72

耐药类型	菌株数	构成比(%)	耐药类型	菌株数	构成比(%)
耐异烟肼	12	23.53	耐利福平	1	1.96
耐链霉素	11	21.57	耐莫西沙星+吡嗪酰胺	1	1.96
耐异烟肼+链霉素	6	11.76	耐莫西沙星+氧氟沙星	1	1.96
耐利福平+利福布汀	4	7.84	耐氧氟沙星	1	1.96
耐莫西沙星+氧氟沙星+左氧氟沙星	4	7.84	耐异烟肼+莫西沙星+氧氟沙星+左氧氟沙星	1	1.96
耐莫西沙星	2	3.92	耐异烟肼+利福平+利福布汀	1	1.96
耐异烟肼+对氨基水杨酸+丙硫异烟胺	2	3.92	耐异烟肼+利福平+利福布汀+链霉素+吡嗪酰胺+莫西沙星+氧氟沙星+左氧氟沙星	1	1.96
耐吡嗪酰胺	1	1.96	耐14种药物	1	1.96
耐对氨基水杨酸	1	1.96	合计	51	100.00