目的 回顾性分析西安市胸科医院2014-2015年结核分枝杆菌的耐药情况，为本地区结核病的诊断、治疗以及预防提供参考。方法 收集西安市胸科医院2014-2015年门诊、住院患者结核分枝杆菌阳性菌株2 583株，采用比例法对链霉素、异烟肼、利福平、乙胺丁醇、丙硫异烟胺、卷曲霉素、莫西沙星、利福喷丁、阿米卡星、对氨基水杨酸钠、左氧氟沙星共11种抗结核药物的耐药性进行测定。结果 共分离出2 583株结核分枝杆菌，其中耐多药、广泛耐药、一线4种全耐药、二线7种全耐药、11种药物全耐药菌株分别为258、139、116、17、16株，耐药率分别为9.99%、5.38%、4.49%、0.66%、0.62%。对11种抗结核药物单一耐药率，由高到低分别为：异烟肼（23.96%）、链霉素（21.76%）、利福喷丁（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%）、对氨基水杨酸钠（5.81%）、卷曲霉素（3.29%）、阿米卡星（2.09%）、丙硫异烟胺（1.55%）。耐多药菌株对利福喷丁和左氧氟沙星的耐药率较高，分别为87.98%、53.88%。对利福喷丁+左氧氟沙星、莫西沙星+利福喷丁组合的耐药率分别高达51.94%、39.92%。广泛耐药菌株对对氨基水杨酸钠的耐药率最高，为32.37%。结论 2014-2015年西安市胸科医院抗结核病药物单一耐药率虽然呈下降趋势，但耐多药、广泛耐药和全耐药菌株的出现和增加提示还需要更加严格的执行结核病防控策略，防止各种耐药菌株的产生、增加和传播。

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.

陕西省社会发展科技攻关项目（2016SF-032）