骨关节结核病灶中耐多药结核分枝杆菌监测的临床意义

Monitoring of multi drug resistant Mycobacterium tuberculosis in bone and joint lesions of tuberculosis patients

目的探讨骨关节结核病灶中耐多药结核分枝杆菌的分布及耐药性,并对患者疗效及并发症的影响,为临床治疗提供理论依据。方法收集2010年10月-2015年10月医院300例骨关节结核复治患者的临床资料,取患者病灶中的脓液、干酪样物或肉芽组织标本混合为一份标本,对其标本进行细菌分离培养鉴定,分析耐多药结核分枝杆菌的分布并测定其药敏性,比较耐多药结核分枝杆菌的疗效与患者并发症发生率。结果 300例标本中,共分离鉴定出阳性数57株,其中结核分枝杆菌53株占17.67%,非结核分枝杆菌群4株占1.33%;53株结核分支杆菌对异烟肼（INH）、链霉素（SM）、利福平（RFP）、乙胺丁醇（EMB）4种药物的耐药率分别为52.83%、49.06%、50.94%、54.72%;全部敏感患者有效率为100.00%,耐1-2种药物有效率为80.00%,耐3-4种药物治疗有效率44.00%;全部敏感、耐1-2种药物患者有效率高于耐3-4种药物患者,差异均有统计学意义（P〈0.05）;患者寒性脓肿扩大发生率全部敏感为0,耐1-2种药物为20.00%,耐3-4种药物为88.00%;患者窦道发生率全部敏感、耐1-2种药物均为0,耐3-4种药物为32.00%;全部敏感、耐1-2种药物患者寒性脓肿扩大发生率、窦道发生率均低于耐3-4种药物患者,差异均有统计学意义（P〈0.05）。结论骨关节结核复治患者病灶中结核分枝杆菌耐多药,其疗效较差且容易伴随并发症,应进行个体化治疗。

OBJECTIVE To investigate the distribution and drug resistance of multi drug resistant Mycobacterium tuberculosis in bone and joints lesions of tuberculosis patient,and the impact on patient outcomes and complications,so as to provide a theoretical basis for clinical treatment.METHODS The clinical data of 300 cases of bone and joint tuberculosis patients got retreatment from Oct.2010 to Oct.2015 were selected.The pus from lesions in patient,cheese-like material or granulation tissue specimen were mixed as one specimen,which were under culture and identification of bacteria isolated,and analyzed the distribution of multi drugs resistant M.tuberculosis and determined its susceptibility.The efficacy of the multi drugs resistant M.tuberculosis and the incidence of complications were compared.RESULTS From the 300 cases of specimens,57 strains of positive were isolated and identified,among which there were M.tuberculosis 53 strains,accounting for 17.67%,4strains of NTMstrains,accounting for 1.33%.The resistant rates of 53 strains M.tuberculosis to isoniazid（INH）,streptomycin（SM）,rifampicin（RFP）and ethambutol（EMB）were 52.83%,49.06%,50.94% and 54.72%,respectively.The effective rate of all sensitive patients was 100%,resistance to 1or 2drugs 80.00%,resistance to 3to 4kinds of drugs 44.00%.The effective rates of all sensitive and resistant to 1to 2drugs patients were more than patients resisting to 3to 4kinds of drugs,and the differences were significant（P〈0.05）.The incidence rate of cold abscess enlargement in all sensitive patients was 0,1to 2kinds of drug-resistant 20.00%,3to 4kinds of drug-resistant 88.00% The incidence rates of sinus in all sensitive,1to 2kinds of drug-resistant patients were both 0%,3to 4drug-resistant patients 32.00%.The incidence rates of cold abscess enlargement and sinus in all sensitive and resistant to 1to 2kinds medication-resistant patients were lower than 3to 4kinds of medication-resistant patients,and the differences were was significant（P〈0.05）.CONCLUSIONThe M.tuberculosis in bone and joint lesions in patients with tuberculosis retreatment are multi drugs resistant with poor efficacy and easy accompanying complications,so the treatment should be individualized.