Harada Y, Kitahara Y, Ninomiya H, Harada S, Takamoto M, Ishibashi T
Department of Internal Medicine, National Ohmuta Hospital, Fukuoka, Japan.
Kekkaku. 1994 Dec;69(12):751-7.
Previously untreated 347 tuberculosis patients newly admitted to our hospital from 1980 to 1991 with positive bacilli and the full record of the drug sensitivity tests were analysed in this study. Among them, 49 cases showed primary resistance to either of major 4 anti-tuberculosis drugs (SM, INH, EB, RFP). The results obtained were as follows: 1. The number of patients with positive bacilli increased with age. The rate of primary drug resistance in patients of age group below 49 were significantly higher than that of age group over 50. 2. The rate of resistance was 8.6% to SM, 4.0% to INH, 1.4% to RFP and 0.6% to EB. These results are consistent with the results of studies of the Tuberculosis Research Committee, Ryoken. EB was frequently substituted to resistant drugs. 3. There was no significant difference between a group with primary resistance and a sensitive group in the various risk and intractable factors, laboratory data as a indicator of risk factors, and in the results of tuberculin skin test. There was also no significant difference in the rate of culture negative conversion of tubercle bacilli and the improvement in radiological findings. 4. We could rarely find the source of infection in 49 cases with primary resistance. In only 5 cases, family contacts were suspected and in another 1 case, the contact in a work place was suspected.
本研究分析了1980年至1991年新入院的347例既往未接受治疗、痰菌阳性且有完整药敏试验记录的肺结核患者。其中,49例对4种主要抗结核药物(链霉素、异烟肼、乙胺丁醇、利福平)中的任何一种表现出原发耐药。结果如下:1. 痰菌阳性患者数量随年龄增加而增多。49岁以下年龄组患者的原发耐药率显著高于50岁以上年龄组。2. 对链霉素的耐药率为8.6%,对异烟肼为4.0%,对利福平为1.4%,对乙胺丁醇为0.6%。这些结果与Ryoken结核病研究委员会的研究结果一致。乙胺丁醇常被替换为耐药药物。3. 在各种危险因素和难治因素、作为危险因素指标的实验室数据以及结核菌素皮肤试验结果方面,原发耐药组和敏感组之间无显著差异。结核杆菌培养转阴率和影像学表现改善率也无显著差异。4. 在49例原发耐药患者中,我们很少能找到感染源。仅5例怀疑有家庭接触者,另1例怀疑有工作场所接触者。