【摘要】：利福平是治療結核病的主選藥物之一,隨著它在臨床上的廣泛應用,耐藥情況日漸嚴重。近年來耐多藥結核病(multidrug resistant tuberculosis, MDR-TB)和廣泛耐藥結核病(extensive drug resistant tuberculosis, XDR-TB)已成為結核病控制中亟待解決的問題。利福布汀是近年來出現(xiàn)的利福霉素類新藥,對結核分枝桿菌(Mycobacterium tuberculosis, MTB)及非結核分枝桿菌(non-tuberculous Mycobacterium, NTM),特別是對鳥-胞內分枝桿菌具有較強的活性。本研究希望通過對耐多藥結核分枝桿菌臨床分離株進行利福布汀和利福平交叉耐藥性研究,為利福布汀治療MDR-TB提供依據(jù)。 目的對耐多藥結核分枝桿菌臨床分離株進行利福布汀和利福平交叉耐藥性研究分析,為利福布汀治療MDR-TB提供依據(jù)。 方法2009年6月至2011年1月上海市肺科醫(yī)院收治的痰培養(yǎng)陽性的肺結核患者,全部培養(yǎng)陽性菌株經(jīng)菌種鑒定為結核分枝桿菌后采用BACTEC960測試其對7種抗結核藥物(異煙肼、利福平、氧氟沙星、鏈霉素、乙胺丁醇、阿米卡星和卷曲霉素)的耐藥性。隨機篩選99株耐多藥結核分枝桿菌臨床分離株,在96孔板上檢測利福布汀和利福平對99株耐多藥菌株的90%最低抑菌濃度(MIC9o)。分析利福布汀對耐多藥結核分枝桿菌臨床分離株的的抗菌活性。交叉耐藥率數(shù)據(jù)分析采用X2檢驗,兩組的MIC比較采用的是經(jīng)對數(shù)轉化后行獨立樣本t檢驗進行統(tǒng)計學處理。 結果利福布汀和利福平交叉耐藥率85.9%(85/99)。利福布汀的MIC9o值為≤16mg/L,中位數(shù)為2mg/L；利福平的MIC90值為≥2mg/L,中位數(shù)32mg/L,前者僅為后者的1/8-1/32。低耐利福平組和中耐利福平組的交叉耐藥例數(shù)分別為0/9、5/9,而高耐利福平組幾乎全部交叉耐藥(98.8%,80/81),利福布汀和利福平的交叉耐藥率隨利福平的耐藥程度加大而上升。利福布汀和利福平的交叉耐藥率與耐藥譜無相關性(x2=2.47,P=0.799)。 結論利福布汀對耐多藥MTB有一定的抗菌活性,可作為治療耐多藥結核病的備選藥物。
[Abstract]:Rifampicin is one of the primary drugs for the treatment of tuberculosis. With its wide application in clinical practice, the drug resistance is becoming more and more serious. In recent years, multidrug-resistant tuberculosis (multidrug resistant tuberculosis, MDR-TB) and extensively drug-resistant tuberculosis (extensive drug resistant tuberculosis, XDR-TB) have become urgent problems in tuberculosis control. Rifampicin is a new drug of rifamycin, which has strong activity against Mycobacterium tuberculosis (Mycobacterium tuberculosis, MTB) and non-tuberculous mycobacterium (non-tuberculous Mycobacterium, NTM),). The aim of this study was to provide evidence for rifampicin in the treatment of MDR-TB by cross-resistance of rifampin and rifampicin in clinical isolates of multidrug-resistant Mycobacterium tuberculosis. Aim to study the cross-resistance of rifampicin and rifampicin in clinical isolates of multidrug-resistant Mycobacterium tuberculosis (MDR-TB) in order to provide evidence for rifampicin in the treatment of MDR-TB. Methods from June 2009 to January 2011, all the positive sputum culture strains were identified as Mycobacterium tuberculosis and tested by BACTEC960 for 7 antituberculosis drugs (isoniazid, rifampicin, ioniazid, rifampin). Drug resistance to ofloxacin, streptomycin, ethambutol, amikacin and crocicomycin. 99 clinical isolates of multidrug-resistant Mycobacterium tuberculosis were randomly screened. The 90% minimal inhibitory concentration (MIC9o) of rifampicin and rifampicin against 99 multidrug-resistant strains was detected on 96-well plate. To analyze the antibacterial activity of rifampicin against multi-drug-resistant clinical isolates of Mycobacterium tuberculosis. The data of cross-resistance rate was analyzed by X2 test, and the MIC of the two groups was compared by independent sample t-test after logarithmic transformation. Results the cross-resistance rate of rifampicin and rifampicin was 85.9% (85 / 99). The MIC9o value of rifampicin was 鈮，

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