目的 分析涂阳肺结核的耐药情况以及相关影响因素。 方法 收集寿县2013~2016年所有痰涂片镜检阳性肺结核患者的相关信息和痰标本,痰标本进行细菌培养和菌种鉴定,对检测出的结核分枝菌和非分支杆菌进行药物敏感性试验。 结果 共调查242例涂阳肺结核患者,其中结核分枝杆菌感染239例(98.8%),非结核分枝杆菌感染3例(1.2%)。239例结核分枝杆菌患者中,总体耐药率为28.9%,单耐药率为14.2%,耐多药率为5.9%,多耐药率为5.9%,广泛耐药率为2.9%;耐药率较高的前四位药物分别为异烟肼(INH)15.5%、链霉素(SM)15.5%、利福平(RFP)13.4%和氧氟沙星(OFX)7.1%;初治195例(81.6%),复治44例(18.4%),初治患者耐药率21.5%,复治患者耐药率61.4 %,差异有统计学意义。多因素logistics回归分析显示复治是总耐药、耐多药、广泛耐药的独立危险因素。 结论 寿县目前肺结核耐药情况依然比较严峻,尤其是复治结核病患者的耐药率较高,应进一步规范结核病治疗方案和管理,加强耐药监测工作,指导临床用药。

Objective To analyze the drug resistance and related factors of smear-positive tuberculosis cases. Methods We collected the relevant information and sputum specimens of patients which were positive sputum smear microscopy in Shou county from 2013 to 2016, and then conducted the bacterial culture, drug sensitivity testing and strain identification. Results A total of 242 cases of smear positive pulmonary tuberculosis were investigated, including 239 cases of mycobacterium tuberculosis infection (98.8%) and 3 cases of non tuberculous mycobacterium infection(1.2%). Among the 239 patients with mycobacterium tuberculosis, the overall drug resistance rate was 28.9%, the mono-resistance rate was 14.2%, MDR-TB rate was 5.9%, the poly-resistance rate was 5.9%, and the XDR-TB rate was 2.9%. The first four drugs with high drug resistance rate were isoniazid (INH) 15.5%, streptomycin (SM) 15.5%, rifampin (RFP) 13.4% and OFX 7.1%. 195 cases (81.6%) were initially treated, 44 cases (18.4%) were retreated. The drug resistance rate of newly diagnosed patients was 21.5%, the resistance rate of retreated patients was 61.4%, and the difference was statistically significant. The multifactor logistic regression analysis showed that the compound was an independent risk factor for total resistance, multidrug resistance and extensive resistance. Conclusion The drug resistance situation was still grim in Shou county, especially in recurrent tuberculosis patients who have higher drug resistance rate. Therefore, we should further standardize the TB treatment and management, strengthen the resistant monitoring work, and guide the clinical medication.