艾滋病合并结核病患者结核分枝杆菌原发耐药的回顾性研究

A retrospective study on primary anti-tuberculosis drug resistance in patients with acquired immunodeficieney syndrome and tuberculosis

目的了解重庆地区艾滋病合并肺结核患者对常见抗结核药物原发耐药情况。方法回顾性分析艾滋病合并肺结核患者119例临床资料，根据抗结核治疗前药物敏感试验结果分析抗结核药物原发耐药发生率及其与CD4＋T淋巴细胞水平、初治/复治、肺结核分型间是否存在相关性。组间比较采用χ2检验。结果119例患者完成药物敏感试验，38例存在结核分枝杆菌耐药现象，占31.9%；其中单耐药14例（11.7%），多耐药9例（7.6%），耐多药8例（6.7%），广泛耐药7例（5.9%）。一线抗结核药物中异烟肼耐药率最高（22.7%，28/119），二线抗结核药物中对氨基水杨酸异烟肼耐药率最高（11.0%，14/119）。患者CD4＋T淋巴细胞计数≤50/μL与〉50/μL比较，耐药率差异无统计学意义（χ2＝0.545，P＝0.461）；CD4＋T淋巴细胞计数≤100/μL与〉100/μL比较，耐药率差异无统计学意义（χ2＝0.652，P＝0.420）。血行播散型肺结核患者总体耐药率为64.0%，高于继发型肺结核患者的27.6%。结论重庆地区艾滋病合并结核病患者抗结核治疗前结核分枝杆菌耐药发生率较高，血行播散性肺结核患者耐药率高于继发型肺结核患者，CD4＋T淋巴细胞计数与耐药无相关性。

Objective To investigate primary anti-tuberculosis drug resistance in patients with acquired immunodeficiency syndrome （AIDS） and tuberculosis in Chongqing area. Methods Clinical data of 119 patients with AIDS and tuberculosis were retrospectively collected. Anti-tuberculosis drug resistance rates were analyzed according to drug susceptibility testing, and their correlations with CD4＋ T lymphocytes counts, initially treatment or retreatment and clinical forms of tuberculosis were also analyzed. Comparison between groups was analyzed by x^2 test. Results Thirty-eight patients （31. 9 %） showed anti-tuberculosis drug resistance among the 119 patients with completed results of drug susceptibility testing results. The percentages of mono-resistance, poly-resistanee, multi-drug resistance （MDR） and extensive drug resistance （XDR） were 11.7%, 7.6%, 6.7% and 5.9%, respectively. The resistance rate of isoniazid （22.7%, 28/119） was the highest among first-line antktuberculosis drugs and that of pasiniazide （11.0%, 14/119） was the highest among secondqine drugs. Drug resistance rates among patients with different levels of CD4＋ T lymphocytes counts did not differ significantly （the cut-off of CD4＋T lymphocytes count was 50/μL.. X2 =0. 545, P=0. 461; cut-off value was 100/μL. X2 =0. 652, P=0. 420）. Patents with milliary pulmonary tuberculosis had a significantly higher drug resistance rate （64.0%） than those with secondary pulmonary tuberculosis （27. 60%）. Conclusions The prevalence of anti-tuberculosis drug resistance prior to anti-tuberculosis treatment initiation is high among AIDS patientswith tuberculosis in Chongqing area. Patients with milliary pulmonary tuberculosis tend to have higher anti- tuberculosis drug resistance, but drug resistance does not appear to correlate with CD4＋ T lymphocytes counts.