重症肺结核患者病原学阳性率及利福平耐药结果分析

Analysis of bacteriological positivity and rifampicin resistance in patients with severe pulmonary tuberculosis

目的:分析重症肺结核患者病原学阳性率及利福平耐药情况,为临床治疗重症肺结核提供参考。方法:选取2023年1—12月首都医科大学附属北京胸科医院收治的临床诊断为肺结核的369例患者为研究对象,其中145例为重症肺结核,224例为轻症肺结核。分析患者痰液抗酸杆菌染色涂片法(涂片法)、BACTEC MGIT 960液体培养法(MGIT 960法)和GeneXpert MTB/RIF(Xpert法)的阳性率及对利福平的耐药情况。结果:重症肺结核患者中,涂片法、培养法和Xpert法的阳性率及病原学总阳性率分别为47.41%(55/116)、68.75%(77/112)、85.82%(115/134)和80.69%(117/145),明显高于轻症患者[29.44%(63/214)、53.17%(109/205)、68.35%(149/218)、71.43%(160/224)],差异均有统计学意义(χ^(2)=10.580,P=0.001;χ^(2)=7.250,P=0.007;χ^(2)=12.512,P<0.001;χ^(2)=4.034,P=0.045)。Xpert法检测阳性的重症与轻症肺结核患者利福平耐药率分别为11.30%(13/115)和8.05%(12/149),差异无统计学意义(χ^(2)=0.800,P=0.371)。Xpert法阳性的重症肺结核中,复治患者利福平耐药率为24.24%(8/33),高于初治患者[6.10%(5/82)],差异有统计学意义(χ^(2)=7.727,P=0.005)。结论:相较于轻症患者,重症肺结核患者的病原学阳性率较高,且Xpert法阳性率最高。重症与轻症肺结核间利福平耐药情况无差异,而重症肺结核复治患者利福平耐药率明显高于初治患者。

Objective:To assess the bacteriological positivity rate and rifampicin resistance in sputum samples from patients with severe pulmonary tuberculosis.Methods:A retrospective analysis was conducted on 369 cases of pulmonary tuberculosis admitted to Beijing Chest Hospital,Capital Medical University,between January and December 2023,including 145 severe and 224 non-severe cases.The positive detection rates of Mycobacterium tuberculosis(MTB)in sputum samples were evaluated using acid-fast staining smear microscopy(smear),BACTEC MIGT 960 culture(culture),and Xpert MTB/RIF(Xpert).Rifampicin resistance was also assessed.Results:In severe pulmonary tuberculosis,the positive rates for smear,culture,and Xpert tests,as well as the overall bacteriological positivity rate,were 47.41%(55/116),68.75%(77/112),85.82%(115/134),and 80.69%(117/145),respectively.In non-severe cases,these rates were 29.44%(63/214),53.17%(109/205),68.35%(149/218),and 71.43%(160/224),respectively.The differences between severe and non-severe cases were statistically significant(χ^(2)=10.580,P=0.001;χ^(2)=7.250,P=0.007;χ^(2)=12.512,P<0.001;χ^(2)=4.034,P=0.045).There was no significant difference in rifampicin resistance rates between patients with severe pulmonary tuberculosis and those with non-severe cases(11.30%(13/115)vs.8.05%(12/149);χ^(2)=0.800,P=0.371).However,rifampicin resistance rates were higher in previously treated cases compared to new cases among Xpert-positive patients(24.24%(8/33)vs.6.10%(5/82);χ^(2)=7.727,P=0.005).Conclusion:Patients with severe pulmonary tuberculosis exhibited a higher bacteriological positivity rate;however,there was no significant difference in rifampicin resistance rates between severe and non-severe cases.Rifampicin resistance rates were notably higher in previously treated cases compared to newly diagnosed cases.