结核分枝杆菌的病原学检测及耐药性分析

发布时间：2019-04-19 03:55

【摘要】：目的探讨结核分枝杆菌的病原学检测及耐药情况。方法回顾性分析2009年1月-2013年12月在本院作痰涂片检查的20 054例患者临床资料,对2012-2013年确诊的160例结核患者作痰涂片抗酸染色检查、结核菌素(PPD)试验和结核抗体试验,并对阳性标本做异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)药敏试验。结果 2009-2013年作痰涂片检查标本结核分枝杆菌的阳性率分别为11.3%、10.1%、8.9%、8.3%、7.7%,呈逐步下降的趋势(χ2=37.396,P0.05),合计阳性率为9.2%(1839/20054)。其中阳性结果以(+)为主(占59.7%),男女比例约为1.7∶1(1 161/678),好发年龄为25~54岁(男女分别占60.9%和60.5%)。与PPD试验(79.4%、47.8%)和结核抗体试验(76.9%、83.3%)相比,痰涂片抗酸染色的灵敏度(28.1%)较低(P0.05),但特异度(100%)较高(P0.05)。99株分离菌中有86株为多耐药菌株,其中耐HR 30株(占34.9%),耐HRS 18株(占20.9%),耐HRE 10株(占11.6%),耐HRSE 28株(占32.6%),其好发年龄为25~54岁,占58.2%。结论痰涂片检查是特异性较强的肺结核诊断方法,联合血清学方法用于诊断肺结核有重要的临床意义。本组资料中痰涂片结核分枝杆菌阳性率逐年下降,但耐药率和多耐药率增高,应加强预防管理工作。
[Abstract]:Objective to investigate the etiological detection and drug resistance of Mycobacterium tuberculosis. Methods from January 2009 to December 2013, the clinical data of 20 054 patients who were examined by sputum smear in our hospital from January 2009 to December 2013 were retrospectively analyzed, and 160 cases of tuberculosis diagnosed from 2012 to 2013 were examined by acid fast staining of sputum smear. Tuberculin (PPD) test and tuberculosis antibody test, and isoniazid (INH), rifampicin (RFP), streptomycin (SM), ethambutol (EMB) susceptibility test were performed on positive samples. Results the positive rates of Mycobacterium tuberculosis in sputum smear from 2009 to 2013 were 11.3%, 10.1%, 8.9%, 8.3%, 7.7%, respectively, showing a gradually decreasing trend (蠂 2, 37.396, P0.05), and the positive rates of Mycobacterium tuberculosis in sputum smears were 11.3%, 10.1%, 8.9%, 8.3%, 7.7%, respectively. The total positive rate was 9.2% (1839 / 20054). The positive results were mainly (59.7%), the ratio of male and female was about 1.7% (1 161? 678), and the age of occurrence was 25? 54 years (60.9% and 60.5%, respectively). Compared with PPD test (79.4%, 47.8%) and tuberculosis antibody test (76.9%, 83.3%), the sensitivity of sputum smear to acid-fast staining (28.1%) was lower (P0.05). But the specificity (100%) was higher (P0.05). Among the 99 isolates, 86 were multi-drug resistant strains, of which 30 (34.9%) were resistant to HR, 18 (20.9%) were resistant to HRS, and 10 (11.6%) were resistant to HRE. 28 strains (32.6%) were resistant to HRSE, and the predominant age was 25 / 54 years old (58.2%). Conclusion sputum smear examination is a highly specific diagnostic method for pulmonary tuberculosis, and combined with serological method is of great clinical significance in the diagnosis of pulmonary tuberculosis. The positive rate of Mycobacterium tuberculosis in sputum smear decreased year by year, but the drug resistance rate and multi-drug resistance rate increased, so prevention and management should be strengthened.
【作者单位】：海南省农垦总医院检验科;海南省农垦总医院感染科;
【基金】：海南省卫生厅医学科研立项课项(琼卫科教〔2014〕51号)
【分类号】：R52;R446.5

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