38例骨关节结核患者病灶标本分枝杆菌培养及药物敏感性试验结果分析

Analysis of mycobacterial culture and drug sensitivity test in 38 patients with osteoarticular tuberculosis

目的 对骨关节结核病灶脓液与肉芽组织分枝杆菌的培养阳性率及药物敏感性试验（简称“药敏试验”）结果进行分析.方法 选择2008年10月至2009年10月在首都医科大学附属北京胸科医院骨科住院并进行手术治疗的骨关节结核患者38例,术中同时采集病灶部位脓液及肉芽组织,采用改良罗氏培养基进行分枝杆菌培养,对培养阳性菌株进行12种抗结核药物（异烟肼、利福平、利福喷丁、乙胺丁醇、链霉素、卡那霉素、阿米卡星、卷曲霉素、氧氟沙星、左氧氟沙星、对氨基水杨酸、丙硫异烟胺）的药敏试验,并分析培养阳性率与患者病程、疗程的关系.结果 38例患者肉芽组织培养阳性率为36.8％ （14/38）,高于脓液培养（21.1％,8/38）,差异有统计学意义（Fisher确切概率法,P＜0.001）;对14例患者肉芽组织培养阳性的菌株进行12种抗结核药物的药敏试验显示：全敏感4例,占28.6％（4/14）;单耐药3例,占21.4％（3/14）;多耐药5例,占35.7％（5/14）;耐多药1例,占7.1％（1/14）;广泛耐药1例,占7.1％（1/14）.病程＜12个月与病程＞12个月的患者,脓液分枝杆菌培养阳性率分别为26.9％（7/26）、8.3％（1/12）,差异无统计学意义（Fisher确切概率法,P=0.393）;肉芽组织分枝杆菌培养阳性率分别为46.2％（12/26）、16.7％（2/12）,差异无统计学意义（Fisher确切概率法,P=0.147）.术前化疗疗程＜2个月的患者脓液分枝杆菌培养阳性率（38.9％,7/18）高于疗程＞2个月的患者（5.0％,1/20）,差异有统计学意义（Fisher确切概率法,P=0.016）;术前化疗疗程＜2个月的患者肉芽组织分枝杆菌培养阳性率（61.1％,11/18）高于疗程＞2个月的患者（15.0％,3/20）,差异有统计学意义（Fisher确切概率法,P=0.006）.结论 骨关节结核患者病灶标本分枝杆菌耐药率较高,术中应尽量采集肉芽组织进行分枝杆菌罗氏培养,以提高培养阳性率;术前化疗时间＜2个月能提高分枝杆菌培养阳性率.

Objective To analyze culture and drug susceptibility testing （DST） of Mycobacterial isolates from pus and granulation tissue in patients with osteoarticular tuberculosis.Methods Thirty-eight cases with osteoarticular tuberculosis admitted in our hospital were enrolled and collected clinical specimens including pus and granulation tissue from focus during Oct.2008 to Oct.2009.All specimens were inoculated to L（o）wenstein-Jensen （L-J） medium and DST covered twelve drugs including isoniazid,rifampicin,rifapentine,ethambutol,streptomycin,kanamycin,amikacin,capreomycin,ofloxacin,levofloxacin,p-aminosalicylate and protionamide was performed further in culture positive specimens.The relationship between the culture positive rate and the course of disease and treat ment was analyzed.Results The culture positive rate of granulation tissues （36.8%,14/38） was higher than that of pus （21.1%,8/38） with significant difference （P〈0.001）.DST in 14 granulation tissues specimens with culture positive showed that full sensitivity was in four cases （28.6 %）,mono-drug resistant tuberculosis in three cases （21.4%）,poly-drug resistance in five cases （35.7%）,multidrug-resistant tuberculosis （MDR-TB） in one case （7.l%） and extensive drug resistance in one cases （7.1%）,respectively.The culture positive rate of pus from patients with disease course more than 12 months （26.9%,7/26） was higher than that of patients with disease course less than 12 months （8.3%,1/12） without significant difference （P=0.393）.The similar result was found in the granulation tissues （46.2% （12/26） vs.16.7% （2/12）,P=0.147）.However,there were significant difference about the culture positive rate of pus between patients with treatment course less than 2 months and more than 2 months （38.9% （7/18） vs.5.0% （1/20）,P=0.016）.The similar result was found in granulation tissues （61.1% （11/18） vs.15.0% （3/20）,P=0.006）.Conclusion The rate of drug resistance is very high in focus of granulation tissues from patients with osteoarticular tuberculosis.Granulation tissues should be collected to culture for Mycobacterial during the operation especially for patients with treatment course less than 2 months.