菌阳结核病患者1494例临床分析

Characteristics of 1494 bacterium positive tuberculosis patients:a clinical analysis

目的分析1494例结核菌培养阳性结核病患者临床资料,为结核病的预防和控制提供参考依据。方法收集2012年1月-2015年12月遵义医学院附属医院门诊和住院所有4486例送检结核菌培养患者中确诊的1494例菌阳结核病患者临床病例资料进行分析。结果 1494例菌阳结核病患者中,男性占59.6%,女性占40.4%;≤18岁占8.9%,19~35岁占20.6%,36~60岁占36.1%、>60岁占34.4%;居住在城镇占42.8%,农村占57.2%。送检的标本中痰液、支气管镜刷检物或灌洗液、经皮肺穿刺物、尿液、创面分泌物及脓肿/包块/淋巴结穿刺物、心包积液、脑脊液、腹水、胸膜组织和胸水的阳性检出率分别为42.2%、46.3%、47.6%、24.3%、37.2%、33.3%、20.1%、8.7%、26.2%、9.6%,总阳性检出率为33.3%。1 494例菌阳结核病患者中,初治者占77.9%,复治者占22.1%;不同特征菌阳结核病患者比较,不同性别、年龄和居住地菌阳结核病患者初治复治分布差异均有统计学意义(均P<0.01);初治者中耐多药患者占0.52%,低于复治者中的12.12%,差异有统计学意义(X^2=116.05,P<0.01)。结论菌阳结核病患者男性多于女性,中老年患者高于中青年患者,农村高于城镇;初治结核病患者较复治患者多,复治患者耐多药比例较初治患者高。

Objective To analyze clinical characteristics of 1 494 tuberculosis patients with positive Mycobacterium culture results and to provide references for tuberculosis treatment and prevention.Methods We extracted and analyzed medical records of 1 494 bacterium positive tuberculosis patients from 4 486 out- and in-patients with Mycobacterium culture for specimens conducted at Affiliated Hospital of Zunyi Medical University from January 2011 through December 2015.Results Of the 1 494 patients,77.9% were initial treatment patients and 22.1% were retreatment patients; 59.6% were male and 40.4% were female; 8.9%,20.6%,36.1%,and 34.4% were aged ≤ 18,19-35,36-60,and ≥ 60 years,respectively;and 42.8% were urban or town residents and 57.2% were rural residents.The overall Mycobacterium positive rate for specimens of the patients was 33.3%,with the positive rate of 42.2% for phlegm samples,46.3% for bronchoscopy specimens,47.6% for percutaneous puncture biopsies,24.3% for urine,37.2% for wound secretion and biopsies of abscess,mass,and lymph node,33.3% for pericardial effusion,20.1% for cerebrospinal fluid,8.7% for ascites,26.2% for pleural tissue,and 9.6% for pleural fluid,respectively.The Mycobacterium positive rate differed significantly by gender,age,living area,and the status of the initial or retreatment （P〈0.01 for all）.The rate of multi-drug resistance （MDR） was significantly lower among the initial treatment patients than among the retreatment patients （0.52% vs.12.12%,χ2=116.05;P〈0.01）.Conclusion The proportions of males,at elder age,living in rural areas,and under initial treatment are higher than those of females,at middle or younger age,living in urban or town regions,and under retreatment among tuberculosis patients with positive Mycobacterium culture.The MDR rate is higher among patients under retreatment than among those under initial retreatment.