结核分枝杆菌临床分离株对吡嗪酰胺的药物敏感性分析

摘要

目的 研究结核分枝杆菌临床分离株对吡嗪酰胺(Pyrazinamide,PZA)的药物敏感性,为结核病的临床用药和防治工作提供参考.方法 应用Bactec MGIT 960系统,检测153株结核分枝杆菌对异烟肼(isoniazid,INH)、利福平(rifampi-cin,RFP)、乙胺丁醇(ethambutol,EMB)、链霉素(streptomycin,Sm)及PZA的耐药性.结果 153株结核分枝杆菌中,PZA耐药34株,耐药率22.2％,无PZA单耐药者.INH,RFP,EMB,Sm耐药和敏感患者的PZA耐药率分别为40.5％(34/84),0％(0/69);47.5 ％(29/61),5.4 ％(5/92);75％(6/8),19.3％(28/145);53.1％(26/49),7.7％(8/104). 54株耐多药菌株(multidrug-resistant tuberculosis,MDR TB)中,有29株同时合并PZA耐药(53.7％),99株非耐多药菌株中,有5株PZA耐药(5.1％),差异有统计学意义(x2=47.854,P＜0.05).经logistic回归分析,Sm耐药、MDR-TB是PZA耐药的危险因素,OR值分别为0.270(95％ CI:0.091～0.802),0.281(95％CI:0.087～0.911).结论 MDR-TB中PZA耐药率较高,PZA的耐药性与MDR-TB及Sm的耐药性有关联,应重视对MDR患者进行PZA药敏试验.%Objective To research the pyrazinamide drug susceptibility of Mycohacterium tuberculosis,and provide reference for clinical medication and prevention.Methods Bactec MGIT 960 system was used to test the resistance of isoniazid,rifam picin,ethambutol,streptomycin and pyrazinamide for 153 strains of Mycobacterium tuberculosis.Results Of 153 Mycobacterium tuberculosis,34 were resistant to PZA,and the resistant rate was 22.2 ％.There was no PZA single drug resistance.A mong patients with and without INH resistance,RFP resistance,EMB resistance and Sm resistance,the proportions of PZA resistance were respectively 40.5 ％ (34/84) vs 0％(0/69),47.5％(29/61) vs 5.4％(5/92),75％(6/8) vs 19.3％(28/145),53.1％ (26/49) vs 7.7％ (8/104).Among the 54 multidrug-resistant (MDR) strains 53.7％ were resistant to PZA,which was significantly higher than 5.1 ％ (5/99) among the nonMDR-TB strains (x2 =47.854,P＜0.05).In multivariate logistic analysis,resistance to Sm (OR=0.270,95％CI:0.091～0.802) and MDR-TB (OR=0.281,95％CI:0.087～0.911) were risk factors to PZA resistance.Conclusion The PZA resistance rate among MDR-TB isolates was high.PZA resistance would be associated with SM resistance and MDR-TB.The drug susceptibility test for PZA is very important to MDR-TB patients.