499例肺结核并发糖尿病患者痰培养阳性菌株的耐药状况调查

回顾性调查沈阳市胸科医院2016年7月至2017年6月住院诊治的痰培养阳性且菌种鉴定为结核分枝杆菌的499例肺结核并发糖尿病患者的耐药检测结果,其中初治患者235例(初治组)、复治患者264例(复治组)。采用绝对浓度法测定结核分枝杆菌对11种抗结核药物的耐药性。结果显示,总耐药率为50.70%(253/499),初治组29.79%(70/235)]低于复治组69.32%(183/264)](χ ²=79.32,P<0.01);单耐药率为14.83%(74/499),初、复治组分别为14.04%(33/235)和15.53%(41/264)]差异无统计学意义(χ ²=0.22,P=0.641);多耐药率为12.63%(63/499),初治组2.98%(7/235)]低于复治组21.21%(56/264)](χ ²=37.47,P<0.01);耐多药率为23.25%(116/499),初治组(12.77%(30/235)]低于复治组32.58%(86/264)](χ ²=27.35,P<0.01);广泛耐药率为3.01%(15/499),初治组0.85%(2/235)]低于复治组4.92%(13/264)](χ ²=7.08,P=0.008);利福平耐药率为29.26%(146/499),初治组15.74%(37/235)]低于复治组41.29%(109/264)](χ ²=39.19,P<0.01)。根据药物敏感性试验结果制定合理有效的耐药肺结核治疗方案,可为临床化疗方案的制定及耐药结核病的防治策略提供参考依据。

Analysis of drug resistance status in 499 sputum culture-positive tuberculosis patients combined with diabetes mellitus

The drug susceptibility testing (DST) results and relevant information were collected from 499 patients who were diagnosed as sputum culture-positive pulmonary tuberculosis (TB), identified as Mycobacterium tuberculosis (MTB) infection and combined with diabetes mellitus (DM), were hospitalized at Shenyang Chest Hospital for treatment from July 2016 to June 2017. The DST results and the related information were retrospective analyzed. Among those enrolled patients, 235 patients were initial treatment cases (initial treatment group) while 264 patients were retreatment cases (re-treatment group). The DST was performed by absolute concentration method for 11 anti-TB drugs. The results showed that the overall drug resistant rate was 50.70% (253/499); the overall drug resistant rate in the initial treatment group (29.79%, 70/235) was statistically significant lower than that in the re-treatment group (69.32%, 183/264) (χ ²=79.32, P<0.01). The mono-drug-resistant rate in 499 MTB strains was 14.83% (74/499); this rate in the initial treatment group and the re-treatment group was 14.04% (33/235) and 15.53% (41/264) respectively, there was no statistically significant difference between the two groups (χ ²=0.22, P=0.641). The poly-drug-resistant rate in 499 MTB strains was 12.63% (63/499); this rate in the initial treatment group (2.98%, 7/235) was statistically significant lower than that in the re-treatment group (21.21%, 56/264) (χ ²=37.47, P<0.01). The multidrug-resistant (MDR) rate in 499 MTB strains was 23.25% (116/499); the MDR rate in the initial treatment group and the re-treatment group was 12.77% (30/235) and 32.58% (86/264) respectively, the former was statistically significant lower than the latter (χ ²=27.35, P<0.01). The extensively drug-resistant (XDR) rate in 499 MTB strains was 3.01% (15/499); the XDR rate in the initial treatment group and the re-treatment group was 0.85% (2/235) and 4.92% (13/264) respectively, and the former was statistically significant lower than the latter (χ ²=7.08, P=0.008). The drug resistant rate of rifampicin was 29.26% (146/499); this rate was 15.74% (37/235) in the initial treatment group, and was statistically significant lower than that in the re-treatment group (41.29%, 109/264) (χ ²=39.19, P<0.01). According to the DST results, the reasonable and effective treatment regimens for drug resistant TB can be established, which can also provide reference for the formulation of clinical chemotherapy regimens and the development of drug-resistant TB prevention and control strategy.