糖尿病合并肺结核耐药情况分析

发布时间：2018-06-27 18:08

本文选题：结核病 + 糖尿病　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:(1)分析糖尿病(DM)合并肺结核(TB)患者对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)四种常用一线抗结核药物耐药情况,为糖尿病合并肺结核患者抗结核治疗提供参考依据;(2)对于糖尿病合并肺结核患者,根据不同糖化血红蛋白水平对耐药率进行比较,为该类患者提供血糖控制水平依据。方法:(1)收集重庆市肺科医院2016年01月~2016年12月痰培养阳性肺结核患者350例,并对其痰抗酸杆菌涂片、菌型鉴定和耐药测验进行回顾性分析。(2)根据耐药检测结果对单纯肺结核组(对照组)、糖尿病合并肺结核组(观察组)患者一线抗结核药物耐药情况进行分析。(3)观察组中按照糖化血红蛋白(GHbA1c)水平,评估不同GHbA1c水平时耐药率的差别。结果:(1)350例肺结核患者中,对照组共计236例,其中,痰抗酸杆菌涂片阳性率为51.7%(122/236),观察组共计58例,其中,痰抗酸杆菌涂片阳性率75.9%(44/58)。观察组痰抗酸杆菌涂片阳性率明显高于对照组,差异有统计学意义(p0.05)。(2)294例患者进行药敏实验总耐药率为60.9%(179/294),对照组总耐药率59.3%(140/236),观察组总耐药率67.2%(39/58),观察组总耐药率虽高于对照组,但差异无统计学意义(p0.05)。(3)单耐药率、多耐药率、耐多药率、广泛耐药率在对照组与观察组中分别为10.2%/12.1%、11.4%/13.8%、24.6%/17.2%、13.1%/24.1%;广泛耐药率对照组明显低于观察组,差异具有统计学意义(p0.05),单耐药率、多耐药率、耐多药率两组差异无统计学意义(p0.05)。(4)对照组与观察组任一耐h、r、s、e耐药率分别为39.0%/44.8%、38.6%/41.4%、47.9%/51.7%、21.2%/24.1%,对照组耐药率均低于观察组,但差异无统计学意义(p0.05)。(5)58例观察组中,糖化血红蛋白㩳7%时,耐药率为30%(3/10),7%~9%时,耐药病例比例79.5%(31/39),9%时,耐药率为55.6%(5/9),不同糖化血红蛋白水平下的耐药率比较,差异具有统计学意义(p0.05)。结论:(1)肺结核对一线结核药物(h、r、s、e)耐药率均大于20%,多耐药率、耐多药率、广泛耐药率大于10%,临床上要高度重视。(2)肺结核患者患糖尿病时,其耐药率较单纯肺结核者高;不同糖化血糖蛋白水平耐药率有明显差异,对于该类患者,不仅要积极降糖治疗,而且应进行结核分枝杆菌培养及药敏实验,通过药敏结果抗结核治疗,降低耐药率,提高疗效。
[Abstract]:Objective: (1) to analyze the drug resistance of isoniazid (INH), rifampicin (RFP), ethambutol (EMB) and streptomycin (SM) in the patients with diabetes (DM) combined with pulmonary tuberculosis (TB), and to provide reference for the anti tuberculosis treatment of diabetic patients with pulmonary tuberculosis. (2) for diabetic patients with pulmonary tuberculosis, according to different saccharification red eggs The rate of drug resistance was compared in white level. Methods: (1) 350 cases of sputum positive pulmonary tuberculosis in Chongqing lung hospital, 01 months ~2016 2016, were collected, and the sputum acid bacilli smear, bacterial identification and drug resistance test were retrospectively analyzed. (2) according to the results of resistance detection to Dan Chunfei Tuberculosis group (control group), diabetes combined with tuberculosis group (observation group) patients with anti tuberculosis drug resistance analysis. (3) in the observation group in accordance with the level of glycated hemoglobin (GHbA1c), the assessment of different GHbA1c levels of the difference in drug resistance. Results: (1) 350 cases of pulmonary tuberculosis, the control group of 236 cases, including sputum acid bacilli smear positive The rate of sex was 51.7% (122/236), and 58 cases in the observation group, of which the positive rate of sputum acid bacilli smear positive was 75.9% (44/58). The positive rate of acid bacilli smear in the observation group was significantly higher than that of the control group (P0.05). (2) the total drug resistance rate of 294 patients was 60.9% (179/294), the total resistance rate of the control group was 59.3% (140/236), the total of the observation group was total. The drug resistance rate was 67.2% (39/58), although the total resistance rate of the observation group was higher than that of the control group, but the difference was not statistically significant (P0.05). (3) the single drug resistance rate, the multidrug resistance rate, the multidrug resistance rate and the widespread resistance rate were 10.2%/12.1%, 11.4%/13.8%, 24.6%/17.2% and 13.1%/24.1% in the control group and the observation group, and the rate of widespread resistance was significantly lower than that in the observation group. There was no significant difference in the single drug resistance rate, multidrug resistance rate and multidrug resistance rate (P0.05). (4) the resistance rates of the control group and the observation group were 39.0%/44.8%, 38.6%/41.4%, 47.9%/51.7%, 21.2%/24.1%, respectively, h, R, s, e, respectively, but there was no significant difference between the control group and the control group, but there was no statistical significance (P0.05). (5) in 58 observation groups, sugar (5) When hemoglobin was 7%, the rate of drug resistance was 30% (3/10), the proportion of drug-resistant cases was 79.5% (31/39), and the resistance rate was 55.6% (5/9) at 9%. The resistance rate under different glycosylated hemoglobin levels was statistically significant (P0.05). Conclusion: (1) the resistance rates of pulmonary nodules to first-line tuberculosis drugs (h, R, s, e) were greater than 20%, multidrug resistance and multidrug resistance. The widespread drug resistance rate is greater than 10%. (2) the drug resistance rate of the patients with tuberculosis is higher than that of those with simple pulmonary tuberculosis, and the resistance rate of glycated glycemic protein is significantly different. For this type of patients, it is not only necessary to actively reduce sugar, but also to carry out the culture of Mycobacterium tuberculosis and the drug sensitivity test, and to resist the drug sensitivity results. Tuberculosis treatment, reduce the drug resistance rate, improve the curative effect.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R521

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