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目的描述张家港市2011年至2015年痰培养阳性的结核病患者的耐药情况,为制定有效的耐药结核病防控策略提供理论依据。方法对2011年1月至2015年11月张家港市临床登记并痰培养阳性的肺结核患者进行一线抗结核药物敏感试验,同时收集人口学和临床资料,进行耐药率分析。结果在获得的294株结核分枝杆菌中,共有93株为耐药菌株,总耐药率31.6%,初、复治患者耐药率为22.2%、57.7%,差异有统计学意义(χ2=33.34;P<0.001);总耐多药率为6.1%,初治患者中未发现耐多药菌株,复治患者耐多药率为23.1%。初治患者以单耐药为主,复治患者以多耐药和耐多药为主。结论张家港市痰培养阳性结核病患者的耐药结核病和耐多药结核病患病率皆处在较高水平。需对初、复治患者根据药敏结果和治疗史做好分类管理,制订合理化疗方案,从而提高治疗效果,有效控制耐药结核病的产生和传播。
Objective To describe the drug resistance of patients with positive sputum culture in TB from 2011 to 2015 in Zhangjiagang, and to provide a theoretical basis for the development of an effective strategy for prevention and control of drug-resistant TB. Methods From January 2011 to November 2015, first-line anti-tuberculosis drug sensitivity test was performed on patients with positive pulmonary tuberculosis who were clinically registered and sputum culture positive in Zhangjiagang City. Demographic and clinical data were also collected for resistance rate analysis. Results Among the 294 Mycobacterium tuberculosis strains, 93 strains were drug-resistant strains with a total resistance rate of 31.6%. The drug resistance rates of primary and retreatment patients were 22.2% and 57.7%, respectively, with significant difference (χ2 = 33.34; P <0.001). The multidrug-resistant rate was 6.1%. No multidrug-resistant strains were found in the newly diagnosed patients. The multidrug resistance rate in retreatment patients was 23.1%. Patients with newly diagnosed single drug-resistant, multi-drug resistant and multidrug-resistant patients. Conclusion The prevalence of drug-resistant TB and MDR-TB in sputum culture-positive TB patients in Zhangjiagang are all at a high level. Patients in primary and recuperation need to be classified and managed according to drug susceptibility results and treatment history so as to formulate a reasonable chemotherapy regimen so as to improve the treatment effect and effectively control the generation and spread of drug-resistant TB.