目的 回顧性分析西安市胸科醫(yī)院2014-2015年結(jié)核分枝桿菌的耐藥情況，為本地區(qū)結(jié)核病的診斷、治療以及預(yù)防提供參考。方法 收集西安市胸科醫(yī)院2014-2015年門診、住院患者結(jié)核分枝桿菌陽(yáng)性菌株2 583株，采用比例法對(duì)鏈霉素、異煙肼、利福平、乙胺丁醇、丙硫異煙胺、卷曲霉素、莫西沙星、利福噴丁、阿米卡星、對(duì)氨基水楊酸鈉、左氧氟沙星共11種抗結(jié)核藥物的耐藥性進(jìn)行測(cè)定。結(jié)果 共分離出2 583株結(jié)核分枝桿菌，其中耐多藥、廣泛耐藥、一線4種全耐藥、二線7種全耐藥、11種藥物全耐藥菌株分別為258、139、116、17、16株，耐藥率分別為9.99%、5.38%、4.49%、0.66%、0.62%。對(duì)11種抗結(jié)核藥物單一耐藥率，由高到低分別為：異煙肼（23.96%）、鏈霉素（21.76%）、利福噴丁（14.83%）、利福平（14.05%）、左氧氟沙星（10.69%）、乙胺丁醇（9.33%）、莫西沙星（6.93%）、對(duì)氨基水楊酸鈉（5.81%）、卷曲霉素（3.29%）、阿米卡星（2.09%）、丙硫異煙胺（1.55%）。耐多藥菌株對(duì)利福噴丁和左氧氟沙星的耐藥率較高，分別為87.98%、53.88%。對(duì)利福噴丁+左氧氟沙星、莫西沙星+利福噴丁組合的耐藥率分別高達(dá)51.94%、39.92%。廣泛耐藥菌株對(duì)對(duì)氨基水楊酸鈉的耐藥率最高，為32.37%。結(jié)論 2014-2015年西安市胸科醫(yī)院抗結(jié)核病藥物單一耐藥率雖然呈下降趨勢(shì)，但耐多藥、廣泛耐藥和全耐藥菌株的出現(xiàn)和增加提示還需要更加嚴(yán)格的執(zhí)行結(jié)核病防控策略，防止各種耐藥菌株的產(chǎn)生、增加和傳播。

Objective To analyze retrospectively the drug resistance of Mycobacterium tuberculosis in Xi'an Chest Hospital from 2014 to 2015, and to provide information for diagnosis, treatment and policy on tuberculosis control. Methods A total of 2 583 strains of positive M. tuberculosis were collected from both the out-patients and in-patients of Xi'an Chest Hospital from 2014 to 2015. The drug resistance of M. tuberculosis against the following eleven antituberculosis agents:streptomycin, isoniazid, rifampicin, ethambutol, protionamide, capreomycin, moxifloxacin, rifapentine, amikacin, p-aminosalicylate sodium, and levofloxacin were detected by absolute concentration method. Results In 2 583 strains of M. tuberculosis, the strains of multidrug-resistant, extensive-drug resistance, resistant to the four first-line drugs, the seven second-line drugs, and the eleven drugs were 258, 139, 116, 17, and 16, accounting for 9.99%, 5.38%, 4.49%, 0.66%, and 0.62%, respectively. The resistant rate of M. tuberculosis against a single drug was listed from high to low as follows:isoniazid (23.96%), streptomycin (21.76%), rifapentine (14.83%), rifampicin (14.05%), levofloxacin (10.69%), ethambutol (9.33%), moxifloxacin (6.93%), p-aminosalicylate sodium (5.81%), capreomycin (3.29%), amikacin (2.09%), and protionamide (1.55%). The resistant rate of multidrug-resistant pathogenic bacteria against rifapentine and levofloxacin were high to 87.98% and 53.88%. The resistant rate of multidrug-resistant pathogenic bacteria against rifapentine + levofloxacin and moxifloxacin + rifapentine was high to 51.94% and 39.92%. The resistant rate (32.37%) of extensive-drug resistance pathogenic bacteria against p-aminosalicylate sodium was highest. Conclusions The drug resistance of M. tuberculosis against a single antituberculosis drug is in a trend of decline in Xi'an Chest Hospital from 2014 to 2015, yet the emergence and increase of the multidrug-resistant and extensive-drug resistance pathogenic bacteria suggest that control strategies should be implemented more strictly to prevent the emergence and spread of the new drug-resistance tuberculosis.

陜西省社會(huì)發(fā)展科技攻關(guān)項(xiàng)目（2016SF-032）