摘要
目的分析中国耐多药结核分枝杆菌(MDR-TB)菌株对二线抗结核药物的敏感性,为耐多药结核病防治政策的制定提供科学依据。方法从全国2007—2008年耐药基线调查收集的菌株中选取2008年4—7月期间耐药基线调查点收集的126株MDR菌株,对其进行2种一线抗结核药物(链霉素和乙胺丁醇)和7种二线抗结核药物(氧氟沙星、卡那霉素、卷曲霉素、乙硫异烟胺、丙硫异烟胺、环丝氨酸和对氨基水杨酸)的敏感性进行检测,分析对不同药物耐药率以及交叉耐药的情况。结果一线药物链霉素和乙胺丁醇,总体耐药率分别为73.0%(92/126)和58.7%(74/126);对于二线药物,氧氟沙星和乙硫异烟胺耐药率最高,分别为25.4%(32/126)和23.0%(29/126);其次为卡那霉素和环丝氨酸,其耐药率分别为17.5%(22/126)和13.5%(17/126);最后为卷曲霉素、丙硫异烟胺和对氨基水杨酸,其耐药率均为3.2%(4/126)。初治患者对卡那霉素(χ2=20.025,P<0.01)和环丝氨酸(χ2=6.558,P=0.017)的耐药率(卡那霉素:20/60,33.3%;环丝氨酸:13/60,21.7%)显著高于复治患者(卡那霉素:2/66,3.0%;环丝氨酸:4/66,6.1%)。此外,卡那霉素和卷曲霉素,乙硫异烟胺和丙硫异烟胺间均存在单向交叉耐药,在对卷曲霉素耐药的4株中,有3株同时对卡那霉素耐药;4株对丙硫异烟胺耐药菌株均同时对乙硫异烟胺耐药。结论我国耐多药结核分枝杆菌菌株对二线抗结核药物具有较高的耐药率,特别是氧氟沙星和乙硫异烟胺,这对我国结核病控制工作,特别是耐多药结核病控制工作的实施带来严峻的挑战。
Objective To analyze drug susceptibility profiles of multi-drug resistant （MDR） M. tuberculosis isolated from China, and provide the scientific evidence for MDR-tuberculosis （MDR-TB） control and prevention. Methods One hundred and twenty-six MDR isolates were selected from the first drug resistant survey in China be- tween April 2008 and July 2008. The conventional drug susceptibility testing was used to detect the drug-resistant profiles against 2 first-line （streptomycin and ethambuol） and 7 second-line anti-tuberculosis drugs （ofloxacin, kana- mycin, capreomyein, ethionamide, protionamide,cycloserine and 4-Amino-2-hydroxybenzoicacid）. The drug-resist- ant proportion and cross resistance were analyzed. Results For first-line drugs, the drug-resistant proportions against streptomycin and ethambuol were 73.0% （92/126） and 58.7% （74/126）, respectively. For second-line drugs, the percentages of the resistance to ofloxacin and ethionamide were the highest, accounting for 25.4% （32/126） and 23.0% （29/126）, respectively. Then, 17.5% （22/126） and 13.5% （17/126） of MDR strains were resistant to kanamycin and cycloserine, respectively. In addition, the drug-resistant rates of capreomycin, pro- tionamide and 4-Amino-2-hydroxybenzoicaeid were all 3. 2% （4/126）. The drug-resistant proportions of kanamycin （χ22= 20. 025,P〈0.01） and cysloserine （χ2= 6. 558, P = 0. 017） in new case group were significantly higher than that in re-treated case group. In addition, there were the cross-resistances between kanamycin and capreomycin, or ethionamide and protionamide. Three of four capreomycin-resistant isolates were resistant to kanamycin, and all four protionamide-resistant strains were resistant to ethionamide meanwhile. Conclusion The high prevalence of M. tuberculosis strains with the resistance to second-line anti-tuberculosis drugs, especially to ofloxacin and ethio- namide in MDR-TB patients was the major challenge on the prevention and control of TB and MDR-TB in China.
出处
《中国防痨杂志》
CAS
2013年第10期831-834,共4页
Chinese Journal of Antituberculosis
基金
中国卫生部与比尔及梅琳达.盖茨基金会结核病防治项目(2009-04-01)
关键词
枝杆菌
结核
抗药性
多种
细菌
抗生素类
抗结核
微生物敏感性试验
Mycobacterium tuberculosis
Drug resistance, multiple, bacterial
Antibiotics, antitubercular
Microbial sensitivity tests
