重庆儿童医院儿童结核病218株分枝杆菌的耐药性及相关因素研究

发布时间：2018-04-15 00:40

本文选题：儿童 + 分枝杆菌　；参考：《重庆医科大学》2014年硕士论文

【摘要】：第一部分218株分枝杆菌菌种鉴定和药物敏感性分析目的：了解我院住院结核病患儿所感染分枝杆菌的菌种和对4种常用抗结核药物的耐药情况，为临床的治疗提供实验数据。方法：将2008年02月-2013年12月期间我院住院结核病患儿的体液标本进行分离培养，培养阳性所得菌株用分枝杆菌药敏罗氏培养基行菌种初步鉴定及对利福平、异烟肼、链霉素、乙胺丁醇4种抗结核药物的耐药性试验。结果：218株分枝杆菌中，结核分枝杆菌为199株（91.5%），牛型分枝杆菌为17株(7.8%)，非结核分枝杆菌菌群为2株(0.9%)。总耐药株数67株（30.7%），耐多药株数14例（6.4%）。四种抗结核药物的耐药率从高到低依次为SM21.6%（47/218）、INH14.2%（31/218）、EMB11.5%（25/218）、RFP6.9%（15/218）。结论：我院住院结核病患儿中存在耐药情况，且近年来有上升趋势。第二部分儿童结核病耐药的危险因素及预后分析目的：分析我院结核病患儿耐药的危险因素及耐药结核病的预后。方法：将2008年02月至2013年12月在重庆医科大学附属儿童医院住院的患儿中结核培养阳性并成功进行药物敏感试验的198例患儿做为研究对象，根据药敏试验结果分为敏感组、耐药组、耐多药组。对198例患儿的流行病学及临床资料进行回顾性分析，耐药组和耐多药组分别与敏感组进行比较，采用卡方检验，对P＜0.05的研究因素行Logistic回归分析，以了解我院结核病患儿耐药、耐多药的危险因素。对所有病例进行电话随访，了解耐药及耐多药患儿的预后情况。结果：198例患儿中男性115例，女性83例，男：女为1.4:1。最小年龄25日龄，最大年龄16岁10月，平均6.20±5.15岁。城镇和农村患儿分别为71例（35.9%）、127例（64.1%）。有卡疤和无卡疤患儿分别为127例(64.1%)、71例(35.9%)。有结核病人接触史的85例（42.9%），否认有接触史的113例(57.1%)。入院前病程≤1月者151例（76.3%），＞1月者47例（23.7%）。播散型结核病80例(40.4%)，非播散型结核118例（59.6%）。胸廓内结核80例（40.4%），胸廓外结核118例（59.6%）。体重低下者48人（24.2%），无体重低下者150人（75.7%）。合并贫血患儿105例（53.0%），，无贫血患儿93例（48.0%）。194例标本行涂片找抗酸杆菌，涂片阳性88例（45.4%），涂片阴性106例(54.6%)。上述研究因素中，敏感组和耐药组在涂片找抗酸杆菌上有显著差异（P=0.01，OR=0.338）；敏感组和耐多药组在入院前病程（P=0.026，OR=4.417）、感染播散性（P=0.012，OR=7.638）等方面有显著差异。耐药组和耐1种药物组在治疗效果上无统计学差异（P=0.947），敏感组和耐≥2种药物组在治疗效果上有显著统计学差异（P=0.000）。结论：敏感组和耐药组在涂片找抗酸杆菌阳性上有显著差异。入院前病程和感染的播散性为耐多药结核病的危险因素。儿童耐药结核病的疗效差，病死率高。
[Abstract]:Part I Identification of 218 strains of Mycobacterium and Analysis of Drug sensitivityObjective: to investigate the mycobacterium species and resistance to four commonly used antituberculous drugs in children with tuberculosis in our hospital, and to provide experimental data for clinical treatment.Methods: from February 2008 to December 2013, the body fluid samples of children with tuberculosis in our hospital were isolated and cultured. The positive strains were identified with Mycobacterium drug sensitive Roche medium and rifampicin, isoniazid and streptomycin were identified.Drug resistance test of 4 antituberculous drugs with ethambutanol.Results among the Mycobacterium species, 199 strains were Mycobacterium tuberculosis, 17 strains were Mycobacterium bovis, and 2 strains were non-tuberculous.The total number of resistant strains was 37. 7 and the number of multi-resistant plants was 6. 4% in 14 cases.The drug resistance rates of the four antituberculous drugs ranged from high to low as follows: SM21.6and 47 / 218and INH14.2N / 31 / 218B / EMB11.5a / 25 / 218r-RFP6.9and 15 / 218g / 218g respectively.Conclusion: drug resistance exists in children with tuberculosis in our hospital, and it is increasing in recent years.Analysis of risk factors and prognosis of Drug Resistance in Children with TuberculosisObjective: to analyze the risk factors and prognosis of drug resistance in children with tuberculosis.Methods: 198 children in Chongqing Medical University affiliated Children's Hospital from February 2008 to December 2013 were divided into sensitive group according to the results of drug sensitivity test.Drug resistance group, multi-drug resistance group.The epidemiological and clinical data of 198 children were analyzed retrospectively. The drug resistance group and the multidrug resistance group were compared with the sensitive group respectively. The chi-square test was used to analyze the factors (P < 0. 05) and the Logistic regression analysis was performed to understand the drug resistance of children with tuberculosis in our hospital.Risk factors for multidrug resistance.All patients were followed up by telephone to understand the prognosis of drug-resistant and multi-drug-resistant children.Results among the 198 children, 115 were male and 83 were female. The ratio of male to female was 1.4: 1.The minimum age was 25 days and the maximum age was 16 years old in October, with an average of 6.20 卤5.15 years old.There were 71 cases in town and 127 cases in countryside.127 cases (64.1%) with and without scar were diagnosed and 71 cases (35. 9%) were diagnosed.85 cases with history of contact with tuberculosis and 113 cases with no history of exposure were found to be 57.1%.The course of disease before admission was less than one month in 151 cases with 76.3% and > one month in 47 cases.There were 80 cases of disseminated tuberculosis and 118 cases of non-disseminated tuberculosis.There were 80 cases of intrathoracic tuberculosis and 118 cases of extrathoracic tuberculosis.48 people with low weight and 150 people without low weight had 75. 75.75%.105 cases with anemia and 93 cases without anemia were examined for acid-fast bacillus by smear, 88 cases with positive smear and 106 cases with negative smear and 54.6 cases with negative smear.Among the above factors, there were significant differences between sensitive group and drug resistant group in finding acid-fast bacilli on smear. There were significant differences between sensitive group and multidrug resistance group in the course of disease before admission, P0.026 ORP 4.417, infection and spread of P0. 012, OR7. 638).There was no significant difference in the therapeutic effect between the resistant group and the drug resistant group (P0. 947), but there was significant difference between the sensitive group and the resistant group (P 0. 000).Conclusion: there is significant difference between sensitive group and drug resistant group in finding acid-fast bacillus in smear.The course of disease and the spread of infection were risk factors of MDR tuberculosis before admission.Children with drug-resistant tuberculosis have poor efficacy and high mortality.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R529.9

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