38例肺切除标本的细菌学评价肺结核疗效监测手段

Evaluation of monitoring methods of chemotherapeutic efficiency on pulmonary tuberculosis by bacteriological study of 38 resected lung specimens

目的分析手术切除的38例肺结核标本的细菌学结果,评价药物疗效的监测手段。方法采集北京胸科医院胸外科自2008年10月至2009年6月行肺结核手术的标本共38例,进行结核菌罗氏培养、药敏试验及菌种鉴定,与术前痰标本的细菌学结果比较,所得培阳率进行统计学分析,采用Fisher确切概率法;并分析与病程、疗程及影像学的关系。结果对所得培阳率进行统计学分析,P=0.033,P<0.05,有统计学意义,认为手术标本中MTB培阳率比痰标本高。24例培阳菌株的药敏结果显示在不同程度上均存在耐药性;病程短于120月(0～120月),疗程短于24月(0～24月),主灶病变为空洞的患者,结核菌培阳率高。结论不能单纯以痰菌结果评价肺结核疗效,而需综合分析患者的病程、疗程及影像学特征。

Objective To evaluate the monitoring method of chemotherapy by analysis of bacteriological study of 38 resected lung specimens.Method 38 cases received surgical treatment for pulmonary tuberculosis in Beijing Chest Hospital from October.2008 to June.2009.38 resected lung specimens were inoculated to the Lowenstein-Jensen medium,and drug susceptibility testing（DST） and species identification were done for the culture-positive.And the results were compared with those of sputum samples before operation.Statistical analysis with Fisher probabilities was performed with the culture-positive rate.The relationship between the bacteriology,the course of disease,treatment and imageology was synthetically analyzed.Results High culture-positive rate was observed for the resected specimens by statistical analysis of the culture positive rate and the statistical difference was significant with P=0.033,P0.05.The DST shown that 24 culture-positive strains were resistant.High culture-positive rate was achieved for patients with course of disease shorter than 120 months（0~120 months）,time of treatment was shorter than 24 months（0~24 months）,and with cavitary lesions.Conclusion It is unreasonable to serve the bacteriology of the sputum samples as the unique indicator to evaluate the chemotherapeutic efficiency.To make it as a method to monitor the efficacy of chemotherapy,integrative analysis on the bacteriology,the course of disease,treatment and imageology should be taken.