不同肺结核患者结核杆菌菌型测定及药物敏感性分析

Determination of mycobacterium tuberculosis types and drug sensitivity in patients with different pulmonary tuberculosis

目的探讨不同肺结核患者结核杆菌菌型测定及药物敏感性。方法收集东莞市松山湖中心医院2019年6月至2021年6月就诊的肺结核患者256份痰液标本[其中,女115例,男141例,年龄20~78(46.59±4.67)岁];进行结核杆菌菌型测定和药物敏感性试验,分析不同菌型的肺结核患者抗结核药物耐药和单一耐药状况。以χ^(2)检验进行比较。结果256份肺结核痰液标本通过分离培养,共培养出228株结核分枝杆菌菌株。根据结核杆菌菌型测定结果不同,其中人结核分枝杆菌占比最高,为82.46%(188/228);其他菌型占比最低,为2.19%(5/228)。药物敏感性试验表明,256例肺结核患者中,一线抗结核药物耐药153例,占59.77%;耐药率最高的药物为异烟肼57例,占22.27%;耐药率最低的药物为乙胺丁醇16例,占6.25%。二线抗结核药物耐药30例,占11.72%;耐药率最高的药物为氧氟沙星12例,占4.69%;耐药率最低的药物为硫酸阿米卡星5例,占1.95%。药物敏感性试验表明,256例肺结核患者中,一线抗结核药物单一耐药76例,占29.69%;单一耐药率最高的药物为异烟肼26例,占10.16%;单一耐药率最低的药物为乙胺丁醇14例,占5.47%。二线抗结核药物单一耐药15例,占5.86%;单一耐药率最高的药物为氧氟沙星8例,占3.13%;单一耐药率最低的药物为硫酸阿米卡星1例,占0.39%。结论肺结核患者结核杆菌菌型以人结核分枝杆菌为主,且肺结核患者的耐药状况较为严重,其对一线抗结核药物的耐药性更高,临床需加强抗结核药的耐药性监测。

Objective To study the determination of mycobacterium tuberculosis types and drug sensitivity in patients with different pulmonary tuberculosis.Methods From June 2019 to June 2021,256 sputum samples of the patients with pulmonary tuberculosis were collected from Dongguan Songshanhu Central Hospital,including 114 females and 141 males who were 20-78(46.59±4.67)years old.After isolation and culture,the mycobacterium tuberculosis type determination and drug sensitivity test were conducted to analyze the status of anti-tuberculosis drug resistance and single drug resistance in the patients with different tuberculosis.χ^(2) test was applied.Results Two hundred and twenty-eight strains of Mycobacterium tuberculosis were isolated from the 256 sputum samples.According to the results of mycobacterium tuberculosis type determination,the human mycobacterium tuberculosis accounted for the highest proportion,82.46%(188/228).Other types of bacteria accounted for the lowest proportion,2.19%(5/228).The drug sensitivity test showed that among the 256 cases of tuberculosis,153 cases were resistant to the first-line anti-tuberculosis drugs,accounting for 59.77%;the drug resistance rate against isoniazid was the highest[22.27%(57/256)];the drug resistance rate against ethambutol was the lowest[6.25%(16/256)].Thirty cases were resistant to the second-line anti-tuberculosis drugs,accounting for 11.72%;the drug resistance rate against ofloxacin was the highest[4.69%(12/256)];the drug resistance rate against Amikacin sulfate was the lowest[1.95%(5/256)].The drug sensitivity test showed that among the 256 cases of tuberculosis,76 cases had single drug resistance against the first-line anti-tuberculosis drugs,accounting for 29.69%;the single drug resistance rate against isoniazid was the highest[10.16%(26/256)];the single drug resistance rate against ethambutol was the lowest[5.47%(14/256)].Fifteen cases had single drug resistance against the second-line anti-tuberculosis drugs,accounting for 5.86%;the single drug resistance rate against ofloxacin was the highest[3.13%(8/256)];the single drug resistance rate against Amikacin sulfate was the lowest[0.39%(1/256)].Conclusions Human mycobacterium tuberculosis is the main form of mycobacterium tuberculosis in patients with tuberculosis.The drug resistance of tuberculosis patients is relatively serious,and their drug resistance to first-line anti-tuberculosis drugs is higher.The clinical resistance monitoring of anti-tuberculosis drugs should be strengthened.