结核分枝杆菌L型的培养及临床研究

A clinical study of L-forms Mycobacterium Tuberculosis Culture.

目的探讨肺结核患者结核分支杆菌L型培养结果与临床状况的关系。方法对151例活动性肺结核、31例非活动性肺结核、27例非肺结核作痰结核分支杆菌L型培养,并分别作痰抗酸涂片、培养、PCR检测,结核分支杆菌L型培养阳性病例进行病程长短、初复治、有无空洞的比较;对70例活动性肺结核、12例非活动性肺结核作外周血结核分支杆菌L型培养。结果151例活动性肺结核、31例非活动性肺结核、27例非肺结核痰结核分支杆菌L型培养阳性分别为30例、3例、0例,其中87例抗酸染色与罗氏培养均阴性的活动性肺结核结核分支杆菌L型培养阳性12例(13.79%)。病程大于12月者明显高于小于1月者(P<0.01),复治病人明显高于初治病人(P<0.01),有空洞者明显高于无空洞者(P<0.05)。结论结核病患者L型结核菌的存在是结核病难治、复发的主要原因之一。开展痰、血等标本的结核分支杆菌L型检测,对于提高结核病诊断正确率有重要意义。

Objective To explore the relationship between L-forms mycobacterium tuberculosis(MTB)culture and clinical condition.Methods Sputum samples obtained from151cases with active pulmonary tuberculosis,31with non-active pulmonary tuberculosis and27with non-tuberculosis disease were detected by L-forms MTB cultuer,sputum smear and PCR.The cases with positive L-forms of MTB were compared in according to disease-course long or short,primary treatment or retreatment,whether cavitation or not.L-forms MTB were cultured from the peripheral blood of70case with active tuberculosis and12cases with non-active tuberculosis.Re sults The positive samples of three groups were30,3and0respectively.Among87cases with active pulmonary tuberculosis,acid-fast stain and L-Y culture nagitive,but 12were MTB positive(13.79%).The cases with disease-course more than12months were higher than those of under1month(P<0.01).The cases of primary treatment were higher than those of retreatment (P<0.01).The cases with cavitation were higher than those without cavitation(P<0.05).Con clu sions The problem of difficult cure and recurrence to the pulmonary tuberculosis are owing to MTB L-forms existence.The results sug-gest that detecting MTB L-forms from sputum and blood is a significant diagnostic way for pulmonary tuberculosis.