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目的了解邯郸市肺结核耐药状况,为今后肺结核规范治疗管理、预防与控制结核病的发生或流行(特别是耐药菌株的流行)和减少传染源提供参考依据。方法将2014年1月~2015年12月年邯郸市辖区16个县(市、区)结核病定点医疗机构、市传染病医院上送的所有初治及复治痰结核分枝杆菌培养阳性病例作为研究对象,采用比例法对4种抗结核药物异烟肼(H)、利福平(R)、左氧氟沙星(Lfx)、卡那霉素(Km)进行治疗前药物敏感试验。结果 (1)4种抗结核药物的总体耐药率顺序由高到低依次为:H(23.17%)、R(19.01%)、Lfx(6.34%)、Km(4.16%);初治组耐药率顺序由高到低依次为:H(16.43%)、R(11.59%)、Km(3.62%)、Lfx(2.66%);复治组耐药率顺序由高到低依次为:H(53.85%)、R(52.75%)、Lfx(23.08%)、Km(6.59%)。(2)505例涂阳肺结核病人总耐药率27.93%,耐多药率13.07%,其中初治组耐药率19.08%、耐多药率6.76%,复治组耐药率68.13%、耐多药率41.76%。(3)复治组耐药率及耐多药率均高于初治组,差异有统计学意义(χ~2=60.64、χ~2=56.89,P<0.05)。结论邯郸市肺结核耐药率处于全国较高水平,防治任务非常严峻,应进一步加强肺结核病人的治疗、督导和管理,提高检测水平和及时病人发现,加大对耐药结核病控制工作的投入。
Objective To understand the status of tuberculosis drug resistance in Handan City, and to provide a reference for standardizing the management and management of tuberculosis, preventing the occurrence and prevalence of tuberculosis (especially the prevalence of drug-resistant strains) and reducing the source of infection in future. Methods From January 2014 to December 2015, all newly diagnosed and retreatment sputum Mycobacterium tuberculosis positive cases sent from TB medical institutions and infectious disease hospitals of 16 counties (cities and districts) in Handan district were selected as In this study, four anti-TB drugs, isoniazid (H), rifampin (R), levofloxacin (Lfx) and kanamycin (Km) Results (1) The overall resistance rates of four kinds of anti-tuberculosis drugs in descending order were H (23.17%), R (19.01%), Lfx (6.34%) and Km The order of drug rates from high to low was H (16.43%), R (11.59%), Km (3.62%) and Lfx (2.66% 53.85%), R (52.75%), Lfx (23.08%), Km (6.59%). (2) The total resistance rate of 505 smear positive pulmonary tuberculosis patients was 27.93%, and the rate of multidrug resistance was 13.07%. The drug resistance rate in initial treatment group was 19.08%, multidrug resistance rate was 6.76%, and the resistance rate in retreatment group was 68.13% Multi-drug rate of 41.76%. (3) The drug resistance rate and multidrug resistance rate in retreatment group were higher than those in naive group (χ ~ 2 = 60.64, χ ~ 2 = 56.89, P <0.05). Conclusion The TB rate in Handan City is at a high level in the country. The task of prevention and treatment is very serious. Treatment, supervision and management of tuberculosis patients should be further strengthened, detection level and timely patient discovery should be enhanced, and investment in drug-resistant tuberculosis control should be increased.