严重耐多药结核病的临床实验室监测

目的 监测结核分枝杆菌对一线和二线抗结核药物的耐药性水平,掌握严重耐多药结核病的流行情况.方法 2004年10月至2007年4月期间山东省胸科医院收集的1021株临床菌株,采用绝对浓度法在鸡蛋培养基上检测1 021株菌株对4种一线和5种二线抗结核药物的药物敏感性.结果 结核分枝杆菌复合群989株(96.9%),非结核分枝杆菌32株(3.1%).989株结核分枝杆菌对一线抗结核药物的总体耐药率为32.3%(95%可信区间为28.7%～35.8%),其中耐多药结核菌株107株(10.8%),有20株菌株符合严重耐多药结核的定义标准.严重耐多药结核菌株占所有耐多药结核菌株的18.7%,全部来自复治肺结核患者.结论 结核分枝杆菌对二线抗结核药物耐药性水平较高,严重耐多药结核在复治结核患者中的流行情况严重.研究显示持续开展抗结核药物耐药性的临床实验室监测十分必要.

Clinical laboratory-base surveillance of extensively drug-resistant tuberculosis

Objective To evaluate the first-line and second-line anti-tuberculosis drugs resistance of clinical Mycobacterium tuberculosis ( M. TB) isolates and the prevalence of Extensively Drug-Resistant Tuberculosis (XDR-TB) in hospital-base TB patients in Shandong province, China. Methods Absolute concentration method based on egg medium were examined for drug-resistance of M. TB strains to 4 first-line anti-tuberculosis drugs (INH, RFP, SM, and EMB) and 5 second-line drugs (FQ,CPM,AMK,and PAS).Results 1021 isolates were obtained from clinical TB patients at Shandong Provincial Chest Hospital during November 2004 to April 2007. Of those, 32 strains ( 3.1% ) were identified to Mycobacterium other than tuberculosis. Among 989 M. TB complexe isolates, the general resistance rate to first-line drugs were 32. 3% (95% CI:28.7% - 35.8% ), 107 isolates ( 10. 8% ) were found to be MDR-TB. According to the revised Global XDR-TB Task Force definition, a total of 20( 18. 7% ) MDR-TB patients met criteria for XDR-TB. All XDR-TB patients were previously treated pulmonary tuberculosis cases. Conclusions The prevalence of resistant to second-line anti-tuberculosis drugs in Mycobacterium tuberculosis was very serious, and high prevalence of XDR-TB in hospital-base patients was found in high-level The study showed that it is important to successively survey the anti-tuberculosis drug resistance in clinical laboratory.