中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2015年
3期
159-163
,共5页
张沥月%胡屹%吴琳琳%蒋伟利%徐飚
張瀝月%鬍屹%吳琳琳%蔣偉利%徐飚
장력월%호흘%오림림%장위리%서표
分枝杆菌,结核%异烟肼%结核,抗多种药物性
分枝桿菌,結覈%異煙肼%結覈,抗多種藥物性
분지간균,결핵%이연정%결핵,항다충약물성
Mycobacterium tuberculosis%Isoniazid%Tuberculosis,multidrug-resistant
目的 探讨对异烟肼耐药的结核分枝杆菌对耐多药结核病流行和传播的影响.方法 选择江苏省灌云县和浙江省德清县定点医疗机构于2010年至2011年确诊的肺结核病患者251例,进行痰标本培养和药物敏感试验,应用散在分布重复单位-数目可变串联重复序列(MIRU-VNTR)基因分型技术对结核分枝杆菌菌株进行基因分型.采用方差分析、非条件Logistic回归方法分析耐药影响因素.结果 251例肺结核病患者痰标本均分离到结核分枝杆菌,对异烟肼耐药共72株,其中对异烟肼单耐药13株,另59株除对异烟肼耐药外,34株对利福平耐药,25株对链霉素和(或)乙胺丁醇耐药.MIRU-VNTR基因分型,可识别29种成簇基因型(包含105株菌株)和146种唯一基因型(包括119株菌株).有25簇包含耐药菌株,有16簇同时出现37株异烟肼耐药菌株和20株耐多药菌株.单因素分析显示,患者性别、年龄、既往治疗史、痰涂片情况与耐多药结核病和异烟肼耐药结核病的发生均有关(均P＜0.05).多因素分析显示,患者的既往治疗史(OR=8.40,95％CI:3.342～21.105)与耐多药结核病发生有关;而与异烟肼耐药结核病发生相关的因素主要是既往治疗史(OR=3.52,95％CI:1.570～7.910)、肺部空洞(OR=2.27,95％CI:1.075～4.799)及痰涂片(OR=0.50,95％CI:0.275～0.892).结论 对异烟肼耐药的结核分枝杆菌近期传播之后有向耐多药结核病演变的趋势,复治结核患者和高龄是发生异烟肼耐药和耐多药结核病的高危人群.
目的 探討對異煙肼耐藥的結覈分枝桿菌對耐多藥結覈病流行和傳播的影響.方法 選擇江囌省灌雲縣和浙江省德清縣定點醫療機構于2010年至2011年確診的肺結覈病患者251例,進行痰標本培養和藥物敏感試驗,應用散在分佈重複單位-數目可變串聯重複序列(MIRU-VNTR)基因分型技術對結覈分枝桿菌菌株進行基因分型.採用方差分析、非條件Logistic迴歸方法分析耐藥影響因素.結果 251例肺結覈病患者痰標本均分離到結覈分枝桿菌,對異煙肼耐藥共72株,其中對異煙肼單耐藥13株,另59株除對異煙肼耐藥外,34株對利福平耐藥,25株對鏈黴素和(或)乙胺丁醇耐藥.MIRU-VNTR基因分型,可識彆29種成簇基因型(包含105株菌株)和146種唯一基因型(包括119株菌株).有25簇包含耐藥菌株,有16簇同時齣現37株異煙肼耐藥菌株和20株耐多藥菌株.單因素分析顯示,患者性彆、年齡、既往治療史、痰塗片情況與耐多藥結覈病和異煙肼耐藥結覈病的髮生均有關(均P＜0.05).多因素分析顯示,患者的既往治療史(OR=8.40,95％CI:3.342～21.105)與耐多藥結覈病髮生有關;而與異煙肼耐藥結覈病髮生相關的因素主要是既往治療史(OR=3.52,95％CI:1.570～7.910)、肺部空洞(OR=2.27,95％CI:1.075～4.799)及痰塗片(OR=0.50,95％CI:0.275～0.892).結論 對異煙肼耐藥的結覈分枝桿菌近期傳播之後有嚮耐多藥結覈病縯變的趨勢,複治結覈患者和高齡是髮生異煙肼耐藥和耐多藥結覈病的高危人群.
목적 탐토대이연정내약적결핵분지간균대내다약결핵병류행화전파적영향.방법 선택강소성관운현화절강성덕청현정점의료궤구우2010년지2011년학진적폐결핵병환자251례,진행담표본배양화약물민감시험,응용산재분포중복단위-수목가변천련중복서렬(MIRU-VNTR)기인분형기술대결핵분지간균균주진행기인분형.채용방차분석、비조건Logistic회귀방법분석내약영향인소.결과 251례폐결핵병환자담표본균분리도결핵분지간균,대이연정내약공72주,기중대이연정단내약13주,령59주제대이연정내약외,34주대리복평내약,25주대련매소화(혹)을알정순내약.MIRU-VNTR기인분형,가식별29충성족기인형(포함105주균주)화146충유일기인형(포괄119주균주).유25족포함내약균주,유16족동시출현37주이연정내약균주화20주내다약균주.단인소분석현시,환자성별、년령、기왕치료사、담도편정황여내다약결핵병화이연정내약결핵병적발생균유관(균P＜0.05).다인소분석현시,환자적기왕치료사(OR=8.40,95％CI:3.342～21.105)여내다약결핵병발생유관;이여이연정내약결핵병발생상관적인소주요시기왕치료사(OR=3.52,95％CI:1.570～7.910)、폐부공동(OR=2.27,95％CI:1.075～4.799)급담도편(OR=0.50,95％CI:0.275～0.892).결론 대이연정내약적결핵분지간균근기전파지후유향내다약결핵병연변적추세,복치결핵환자화고령시발생이연정내약화내다약결핵병적고위인군.
Objective To investigate the impact of isoniazid (INH)-resistant Mycobacterium tuberculosis (Mtb) on the prevalence and dissemination of multi-drug resistant tuberculosis (MDR-TB).Methods A total of 251 patients diagnosed with tuberculosis in designated hospitals of Guanyun,Jiangsu and Deqing,Zhejiang from 2010 to 2011 were included in the study.The drug susceptibility tests (DST) were performed on all the Mtb isolates available from the sputum cultures.Mycobacteral interspersed repetitive units-variable number tandem repeats (MIRU-VNTR) was conducted for genotyping for all available Mtb isolates.Chi-square test,Fisher exact test,ANOVA and non-conditional Logistic regression modelling were applied for data analysis.Results Among 251 patients with Mtb isolates and DST results available,72 (28.7％) were resistant to INH,including 13 were INH mono-drug resistant.Of the remaining 59 INH-resistant Mtb,34 (13.5％) were resistant to rifampin TB and 25 were resistant to streptomycin and/or ethambutol.The clustering analysis based on MIRU-VNTR genotyping revealed 29 clustered genotypes (including 105 isolates) and 146 unique genotypes (including 119 isolates).Twentyfive clusters contained drug resistant Mtb and 16 clusters of them comprised by 37 INH-resistant isolates and 20 MDR-TB isolates,which accounted for 51.4％ of the INH-resistant isolates and 58.8％ of the MDR-TB isolates.Single factor analysis showed that sex,age,previous tuberculosis treatment history and sputum smear results were all related to INH-resistant tuberculosis and MDR-TB (all P ＜ 0.05).Multiple factors analysis showed that previous tuberculosis treatment history was risk factor of MDR-TB (OR=8.40,95 ％CI:3.342-21.105),while the risk factors of INH-resistant tuberculosis were previous tuberculosis treatment history (OR=3.52,95％CI:1.570-7.910),pulmonary caviry (OR=2.27,95％CI:1.075-4.799) and sputum smear results (OR=0.50,95％CI:0.275-0.892).Conclusions That INH-resistant strain may evolve to the MDR-TB after recent transmission is a possible trend.Patients with previous treatment history and advanced age are at high risk of INH-resistant tuberculosis and MDR-TB.
