结核分枝杆菌药物敏感性试验分析及耐多药结核患者外周血细胞因子检测

发布时间：2018-05-13 01:26

本文选题：结核分枝杆菌 + 莫西沙星　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：研究结核分枝杆菌（MTB）对莫西沙星（MFX）、左氧氟沙星（LFX）和氧氟沙星（OFX）三种临床常用氟喹诺酮类药物的敏感性，分析其耐药状况，为临床用药提供依据。同时探讨耐多药肺结核患者的血清TNF-α、IFN-γ变化及意义。方法：采用比例法对莫西沙星和异烟肼（INH）、链霉素（SM）、利福平（RFP）、乙胺丁醇（EMB）、氧氟沙星（OFL）、左氧氟沙星（LVF）、环丙沙星（CIP）、丙硫异烟胺（TH1321）、对氨基水杨酸（PAS）、阿米卡星（Am）分别做药物敏感性试验。根据药物敏感性试验结果、采用双抗体夹心ELASA方法测定耐多药肺结核患者血清TNF-α、IFN-γ的变化。结果：（1）750例肺结核患者痰标本中，培养法共检出阳性标本376例，其中，莫西沙星有64株发生耐药，耐药率为17.0%；异烟肼60.6%、链霉素44.1%、利福平51.5%、乙胺丁醇42.0%、氧氟沙星37.6%、左氧氟沙星25.0%、丙硫异烟胺52.1%、对氨基水杨酸56.9%、环丙沙星66.5%、阿米卡星44.1%。（2）耐多药肺结核患者的血清TNF-α、IFN-γ显著高于敏感组（P＜0.05）。耐多药肺结核患者血清TNF-α的检测结果显示随着病灶范围增加TNF-α的水平减少，1~2肺野组TNF-α的水平明显高于5~6肺野组（P＜0.01）；无空洞组血清TNF-α平均值高于有空洞组（P＜0.05）。耐多药肺结核病人的血清IFN-γ的检测结果显示5~6个肺野组比3~4肺野组高（P＜0.05）。结论：（1）耐药结核病的发生除了与结核分枝杆菌产生耐药性有关以外，免疫功能紊乱是另一重要因素，，耐多药结核病患者结核分枝杆菌在机体内引起较强烈地免疫反应，导致外周血中TNF-α、IFN-γ水平变化，这些细胞因子在结核病的发病过程中起着一定的作用，而且与病情严重程度密切相关。（2）目前在结核分枝杆菌药物敏感性试验中，氧氟沙星和左氧氟沙星已出现较高的耐药率,值得临床医生重视。莫西沙星显示出良好的抗菌效果，是一种有效的抗结核药物，给耐药结核病的治疗带来希望。使用时亦应做结核菌敏感性测试，了解其耐药情况，科学指导临床进行有针对性的治疗措施。
[Abstract]:Objective: to study the sensitivity of Mycobacterium tuberculosis (MTB) to three kinds of commonly used fluoroquinolones (MFX), levofloxacin (LFX) and ofloxacin (OFX). To explore the change and significance of serum TNF- 伪 and IFN- 纬 in multidrug resistant pulmonary tuberculosis patients. Methods: the sensitivity of moxifloxacin, isoniazid, streptomycin, rifampicin, EMBO, ofloxacin, levofloxacin, ciprofloxacin, TH1321, aminosalicylate PASN and amicacin Amm were tested by proportional method. According to the results of drug sensitivity test, the changes of serum TNF- 伪 and IFN- 纬 in patients with multidrug resistant pulmonary tuberculosis were determined by double antibody sandwich ELASA method. Results out of 750 sputum samples of Pulmonary tuberculosis patients, 376 positive samples were detected by culture method. Among them, 64 strains were resistant to moxifloxacin. Isoniazid 60.6, streptomycin 44.1, rifampicin 51.5, ethambutanol 42.0, ofloxacin 37.6um, levofloxacin 25.0, propyl isoniacin 52.1, p-aminosalicylic acid 56.9, ciprofloxacin 66.5, amikacin 44.1. (2) the serum TNF- 伪 IFN- 纬 level in multidrug resistant pulmonary tuberculosis patients was significantly higher than that in sensitive group (P < 0.05). The results of serum TNF- 伪 detection in multidrug resistant pulmonary tuberculosis patients showed that the level of TNF- 伪 in the lung field group was significantly higher than that in the lung field group (P < 0.01) and the mean value of TNF- 伪 in the non-cavity group was higher than that in the empty group (P < 0.05). The results of serum IFN- 纬 detection in multidrug resistant pulmonary tuberculosis patients showed that the levels of IFN- 纬 in 5 ~ 6 lung field group were higher than those in 3 ~ 4 lung field group (P < 0. 05). Conclusion: 1) the occurrence of drug-resistant tuberculosis (MDR-TB) is not only related to the drug resistance of Mycobacterium tuberculosis, but also to the disorder of immune function. The mycobacterium tuberculosis in MDR-TB patients causes a stronger immune response in the body. These cytokines play a certain role in the pathogenesis of tuberculosis and are closely related to the severity of the disease. At present, ofloxacin and levofloxacin have a high drug resistance rate in Mycobacterium tuberculosis drug sensitivity test, which is worthy of attention by clinicians. Moxifloxacin shows good antibacterial effect and is an effective anti-tuberculosis drug, which brings hope to the treatment of drug-resistant tuberculosis. The sensitivity test of tuberculous bacilli should be done to understand the drug resistance of tuberculous bacilli and to guide the clinical treatment scientifically.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521

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