中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2011年
8期
689-694
,共6页
李静%沈鑫%张阳奕%罗涛%杨崇广%郭俊涛%江渊%武洁%王莉莉%桂晓虹%高谦%梅建
李靜%瀋鑫%張暘奕%囉濤%楊崇廣%郭俊濤%江淵%武潔%王莉莉%桂曉虹%高謙%梅建
리정%침흠%장양혁%라도%양숭엄%곽준도%강연%무길%왕리리%계효홍%고겸%매건
分枝杆菌%结核%抗药性%多药%喹诺酮类%氧氟沙星
分枝桿菌%結覈%抗藥性%多藥%喹諾酮類%氧氟沙星
분지간균%결핵%항약성%다약%규낙동류%양불사성
Mycobacterium tuberculosis%Drug resistance,multiple%Quinolones%Ofloxacin
目的 了解上海地区肺结核病患者氧氟沙星耐药的分布情况及可能的危险因素.方法 收集2009-2010年上海市各结核病定点医院的447株对任意一种一线抗结核药物(异烟肼、利福平、链霉素和乙胺丁醇)耐药的菌株,同期随机选取151株对上述4种一线抗结核药物全敏感菌株,对这598株结核分枝杆菌菌株进行氧氟沙星敏感性检测,分析氧氟沙星耐药的分布情况.收集肺结核患者的年龄、性别、抗结核治疗史和户籍资料,采用多因素分析研究氧氟沙星耐药可能的危险因素.用DNA测序分析氧氟沙星耐药菌株gyrA、gyrB基因耐药突变的特征.结果 447株耐药菌株中,72株(16.1%)对氧氟沙星耐药,MDR(至少同时对异烟肼、利福平耐药)结核分枝杆菌中氧氟沙星耐药44株(39.6%).在151株一线抗结核药物全敏感菌株中,4株(2.6%)耐氧氟沙星.多因素分析结果显示MDR和多耐药(对一种以上抗结核药物耐药,但不对异烟肼和利福平同时耐药)等与氧氟沙星耐药有关(OR分别为19.5、5.6,95% CI 分别为6.4～59.4、1.7～18.1,P均＜0.05).患者为复治病例与氧氟沙星耐药相关(OR=2.3,95%CI:1.2～4.0,P＜0.05).氧氟沙星耐药与年龄偏大有关(OR=1.03,95%CI:1.01～1.05,P＜0.05).76株氧氟沙星耐药菌株的gyrA、gyrB基因序列分析显示62株(81.6%)发生耐药突变.结论 上海地区MDR结核病患者中氧氟沙星耐药率高于对一线抗结核药物全敏感的肺结核病患者.MDR、多耐药、复治、年龄为氧氟沙星耐药可能的危险因素,其中以MDR与氧氟沙星耐药的关联强度最大.
目的 瞭解上海地區肺結覈病患者氧氟沙星耐藥的分佈情況及可能的危險因素.方法 收集2009-2010年上海市各結覈病定點醫院的447株對任意一種一線抗結覈藥物(異煙肼、利福平、鏈黴素和乙胺丁醇)耐藥的菌株,同期隨機選取151株對上述4種一線抗結覈藥物全敏感菌株,對這598株結覈分枝桿菌菌株進行氧氟沙星敏感性檢測,分析氧氟沙星耐藥的分佈情況.收集肺結覈患者的年齡、性彆、抗結覈治療史和戶籍資料,採用多因素分析研究氧氟沙星耐藥可能的危險因素.用DNA測序分析氧氟沙星耐藥菌株gyrA、gyrB基因耐藥突變的特徵.結果 447株耐藥菌株中,72株(16.1%)對氧氟沙星耐藥,MDR(至少同時對異煙肼、利福平耐藥)結覈分枝桿菌中氧氟沙星耐藥44株(39.6%).在151株一線抗結覈藥物全敏感菌株中,4株(2.6%)耐氧氟沙星.多因素分析結果顯示MDR和多耐藥(對一種以上抗結覈藥物耐藥,但不對異煙肼和利福平同時耐藥)等與氧氟沙星耐藥有關(OR分彆為19.5、5.6,95% CI 分彆為6.4～59.4、1.7～18.1,P均＜0.05).患者為複治病例與氧氟沙星耐藥相關(OR=2.3,95%CI:1.2～4.0,P＜0.05).氧氟沙星耐藥與年齡偏大有關(OR=1.03,95%CI:1.01～1.05,P＜0.05).76株氧氟沙星耐藥菌株的gyrA、gyrB基因序列分析顯示62株(81.6%)髮生耐藥突變.結論 上海地區MDR結覈病患者中氧氟沙星耐藥率高于對一線抗結覈藥物全敏感的肺結覈病患者.MDR、多耐藥、複治、年齡為氧氟沙星耐藥可能的危險因素,其中以MDR與氧氟沙星耐藥的關聯彊度最大.
목적 료해상해지구폐결핵병환자양불사성내약적분포정황급가능적위험인소.방법 수집2009-2010년상해시각결핵병정점의원적447주대임의일충일선항결핵약물(이연정、리복평、련매소화을알정순)내약적균주,동기수궤선취151주대상술4충일선항결핵약물전민감균주,대저598주결핵분지간균균주진행양불사성민감성검측,분석양불사성내약적분포정황.수집폐결핵환자적년령、성별、항결핵치료사화호적자료,채용다인소분석연구양불사성내약가능적위험인소.용DNA측서분석양불사성내약균주gyrA、gyrB기인내약돌변적특정.결과 447주내약균주중,72주(16.1%)대양불사성내약,MDR(지소동시대이연정、리복평내약)결핵분지간균중양불사성내약44주(39.6%).재151주일선항결핵약물전민감균주중,4주(2.6%)내양불사성.다인소분석결과현시MDR화다내약(대일충이상항결핵약물내약,단불대이연정화리복평동시내약)등여양불사성내약유관(OR분별위19.5、5.6,95% CI 분별위6.4～59.4、1.7～18.1,P균＜0.05).환자위복치병례여양불사성내약상관(OR=2.3,95%CI:1.2～4.0,P＜0.05).양불사성내약여년령편대유관(OR=1.03,95%CI:1.01～1.05,P＜0.05).76주양불사성내약균주적gyrA、gyrB기인서렬분석현시62주(81.6%)발생내약돌변.결론 상해지구MDR결핵병환자중양불사성내약솔고우대일선항결핵약물전민감적폐결핵병환자.MDR、다내약、복치、년령위양불사성내약가능적위험인소,기중이MDR여양불사성내약적관련강도최대.
Objective To investigate the prevalence and risk factor of Ofloxacin resistance among the tuberculosis patients in Shanghai.Methods Totally 447 isolates resistant to anyone of first-line drug (Isoniazid,Rifampicin,Streptomycin and Ethambutol) and 151 randomly selected isolates susceptible to all above drugs were collected from district tuberculosis(TB) hospitals in Shanghai during 2009 to 2010.All 598 isolates were subject to Ofloxacin sensitive test.Logistic regression analysis was conducted to determine risk factors of Ofloxacin resistance.DNA sequencing was applied to study the mutation characteristics in gyrA and gyrB among Ofloxacin resistant isolates.Results Seventy-two(16.1%) of the 447 drug-resistant isolates were found resistant to Ofloxacin,and the Ofloxacin resistant rate among multiple drug-resistant (MDR) isolates was 39.6%(44/111).Ofloxacin resistance was also found in 4(2.6%) of the 151 drug sensitive isolates.Logistic regression analysis showed that first-line drug-resistance MDR(resistant to at least rifampin and isoniazid) and poly-drug resistance(resistance to two or more first-line drugs but not MDR) had significant effect on Ofloxacin resistance(OR = 19.5、5.6,95% CI:6.4 - 59.4、1.7 - 18.1,all P＜ 0.05);re-treatment(OR = 2.3,95 % CI:1.2 -4.0,P＜ 0.05),and a higher age(OR = 1.03,95 % CI:1.0 1 - 1.05,P＜ 0.05)were also significantly associated with Ofloxacin resistance.Resistance mutations in the gyrA and gyrB genes were detected in 62 of 76(81.6%) isolates with phenotypic Ofloxacin-resistance. Conclusions The Ofloxacin resistance rate in Shanghai MDR-TB patients is significantly higher than the pan-susceptible TB patients.Risk factors of ofloxacin resistance are MDR,poly-resistant,retreated patients,age.Among them,MDR has the highest strength of association.
