肺结核患者合并肺部感染病原菌的种类、血清蛋白水平及分枝杆菌耐药性分析

Pathogen isolation,serum protein detection,and analysis of Mycobacterium tuberculosis resistance in 75 patients with pulmonary tuberculosis and a microbial infection

目的对75例肺结核患者合并肺部感染病原菌进行分离鉴定,并测定其血清蛋白质以及分枝杆菌的耐药性。方法选取2018年1月-2019年1月本院收治的肺结核合并肺部其它病原菌感染患者75例(观察组),体检健康者40例(对照组)。采集观察组患者痰液标本进行病原菌的分离鉴定,并对分离的结核分枝杆菌进行药敏测定;采集两组受检者血液,分离血清,采用ELISA检测触珠蛋白(HP)、基质蛋白酶抑制剂-1(TIMP-1)和脯氨酸肽酶(PEPD)并进行比较分析。结果观察组患者合并肺部感染病原菌主要为革兰阴性菌,占54.95%(50/91),革兰阳性菌占34.07%(31/91),真菌占10.99%(10/91);测定血清HP、PEPD,观察组分别为(1 450.16±893.17)μg/mL、(1 251.89±779.80)μU/mL,对照组分别为(921.68±696.46)μg/mL、(946.20±443.11)μU/mL,差异均有统计学意义(均P<0.05)。TIMP-1水平两组间差异无统计学意义(P>0.05)。共分离出75株结核分枝杆菌,药敏试验显示其对RFP、INH、Lfx、Sm、EMB、Pto、Cm和Am的耐药率分别为52.00%、50.67%、36.00%、30.67%、26.67%、16.00%、8.00%和6.67%,总耐药率66.67%,一耐比率为8.00%,二耐及以上的比率为58.67%。结论肺结核合并肺部感染的病原菌以革兰阴性菌和革兰阳性菌为主,血清HP和PEPD水平显著升高,且结核分枝杆菌多药耐药严重,临床上应依据药敏试验结果合理选用抗菌药物治疗。

Objectives To isolate and identify pathogens in 75 patients with pulmonary tuberculosis and a microbial infection and to determine serum proteins and drug resistance of Mycobacterium tuberculosis.Methods Seventy-five patients with pulmonary tuberculosis and a microbial infection seen at this Hospital from January 2018 to January 2019 served as the observation group.In addition,40 healthy people who underwent a physical examination at this Hospital during the same period served as the control group.The pathogens causing a pulmonary infection in the observation group were isolated and identified,and levels of haptoglobin(HP),matrix protease inhibitor-1(TIMP-1),and proline peptidase(PEPD)in the observation group and the control group were determined using ELISA.M.tuberculosis isolated from the observation group was subjected to a drug sensitivity test.Results The main pathogens causing a pulmonary infection in the observation group were Gram-negative bacteria(50/91,54.95%),followed by Gram-positive bacteria(31/91,34.07%)and fungi(10/91,10.99%).Serum HP was 1,450.16±893.17 g/mL and serum PEPD was 1,251.89±779.80 U/mL in the observation group;serum HP was 921.68±696.46 g/mL and serum PEPD was 946.20±443.11 U/mL in the control group.Serum HP and PEPD levels differed significantly(P<0.05).TIMP-1 levels did not differ significantly between the two groups(P>0.05).A drug susceptibility test indicated that 75 strains of M.tuberculosis were resistant to RFP at a rate of 52.00%,to INH at a rate of 50.67%,to Lfx at a rate of 36.00%,to Sm at a rate of 30.67%,to EMB at a rate of 26.67%,to Pto at a rate of 16.00%,to Cm at a rate of 8.00%,and to Am at a rate of 6.67%.Overall drug resistance was 66.67%.Eight percent of the M.tuberculosis strains were resistant to a single drug,and 58.67%were resistant to 2 or more drugs.Conclusion Gram-negative bacteria and Gram-positive bacteria were the main pathogens found in patients with pulmonary tuberculosis and a microbial infection.The serum levels of HP and PEPD in the observation group were significantly higher than those in the healthy control group.M.tuberculosis is highly drug-resistant,so antibiotics should be selected rationally according to the results of drug sensitivity testing.