肺结核患者300例耐药性分析

目的：探讨肺结核患者结核分枝杆菌（MTB）的耐药性及基因突变情况。方法：选取2006年1月至2008年1月间我院全部新发及复治的首次痰培养MTB阳性的300例患者进行药敏试验及基因突变检测分析。结果：初治组耐≥1种以上药物者占28．95％，耐H＋R或H＋R＋其他药物者占6．14％；复治组耐≥1种以上药物者占44．44％，耐H＋R或H＋R＋其他药物者占22．22％，两者比较差异均具有统计学意义（P〈0．05）。初治组患者结核菌对INH、RFP、SM、EMB及PAS的耐药率明显低于复治组，两者比较差异均具有统计学意义（P〈0．05）。初治组rpoB阳性率及katG阳性率分别是10．53％、7．89％，而复治组rpoB阳性率及katG阳性率分别是36．11％、30．56％，两者比较差异均具有统计学意义（P〈0．05）。结论：结核菌耐药情况严重，基因突变率高，临床应严格按照肺结核病人全程督导化疗（DOTS）方案执行，防止耐药菌的产生，并有效控制传染源。

Analysis on Drug Resistance of 300 Cases Pulmonary Tuberculosis

Objective： To investigate the drug resistance and gene mutation of mycobacterium tuberculosis in case with pulmonary tuberculosis. Method： 300 cases with positive results of MTB sputum culture first time were selected and received susceptibility tests and gene mutation detections. Result： The rate of resistance to more than 1 drug was 28.95% and the rate of resistance to H ＋ R or H ＋ R ＋ others was 6.14% in initial treatment group, and the rate of resistance to more than 1 drug was 44. 44% and the rate of resistance to H ＋ R or H ＋ R ＋ others was 22.22% in retreatment group, and there was significant difference between two groups（P 〈 0.05）. The rate of drug resistance to INH, RFP,SM, EMB and PAS in initial treatment group were lower than those in retreatment group, and there was significant difference between two groups（ P 〈0.05 ）. The masculine rate of rpoB and katG were 10.53% and 7.89% in initial treatment group,and were 36.11% and 30.56% in retreatment group, and there was significant difference between two groups （ P 〈 0.05 ）. Conclusion： The drug resistance of 300 cases with pulmonary tuberculosis is serious and the rate of gene mutation is multiple. So the clinician should abide by DOTS strictly to prevent the drug resistance and to control the infection sources validly.