液体培养分枝杆菌及药敏实验诊断HIV/TB双重感染患者临床价值的研究

The Clinical Value of Liquid Culture and Susceptibility Testing of Mycobacterium from HIV-positive Individuals Suspected of Mycobacteria Infection

目的分析江西省南昌市HIV/TB双重感染患者分枝杆菌特征、菌株特性及耐药情况,为流行病学分析、临床确诊及治疗预后提供依据。方法收取HIV/AIDS疑似感染分枝杆菌患者标本139例(痰标本130例,局部组织等9例,去除重复),采取抗酸染色和菌株分离。将分离出的抗酸菌株传代培养,行菌种鉴定同时做一线药敏试验分析。结果 139份标本分枝杆菌抗酸染色的阳性率为6.5%(9/139)。分离培养出分枝杆菌40株阳性率达28.8%(40/139),经过鉴定显示其中含结核分枝杆菌(MTB)38株,占95.0%,非结核分枝杆菌(NTM)2株占5%。38株MTB对4种一线抗结核药物的耐药率为:异烟肼(INH)7.89%、利福平(RFP)10.52%、链霉素(SM)2.63%、乙胺丁醇(EMB)0.0%,总耐药率为10.52%。结论 MTB感染在南昌HIV/TB双重感染的患者中占主要比例,情况不容忽视;临床应对HIV/TB双重感染患者抗结核一线药物耐药情况重视,合理用药。

Objective To investigate the characterizations and drug resistance of clinically isolated mycobacteria from human immunodeficiency virus （HIV） patients of Nanchang city,it is intended to provide the theoretical basis for epidemiological assessment,clinical diagnosis and treatment. Methods 139 mycobacteria specimens were recruited from HIV-positive individuals suspected of mycobacteria infection （130 sputum cases and nine local organizations ,one single specimen per patient）. All specimens were detected by Acid-fast staining and isolated for culture. Drug susceptibility testing and strain identification were subsequently performed on all isolates. Results The percentage of the smear- and culture-positive specimens were 6.5%（9/139） and 28.8%（40/ 139）,respectively. The strain identification showed that 38 isolates of Mycobacterium tuberculosis （MTB） and two isolates of Nontuberculosis Mycobacteria（NTM） were accounted for 95% and 5% ,respectively. The total resistance rate to four first-line drugs was 10.52% in 38 strains of MTB ,while 7.89%, 10.52%, 2.63% and 0% of 38 strains were Isoniazid-resistant （INH）, Rifampicin-resis- rant （RFP）, Streptomycin-resistant （SM） and Ethambutol-resistant （EMB）, respectively. Conclusions MTB infection ptayed the major role in HIV-positive patients suspected of mycobacteria from Nanchang city. Specifically,the current situation of MTB-resistance to first-line drugs must he emphasized in HIV-positive patients infected Mycobacterium tuberculosis to clinically guide rational administration.