获得性免疫缺陷综合征并发肺结核患者结核分枝杆菌的耐药状况
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摘要
目的了解我院获得性免疫缺陷综合征(AIDS)并发肺结核患者结核分枝杆菌对一、二线抗结核药物的耐药情况。方法选取2010年1月至2017年5月本院收治住院治疗的AIDS并发肺结核患者83例,分离的结核分枝杆菌采用WHO推荐的比例法进行药物敏感实验,以耐药百分比> 1. 0%判定该菌对该药物耐药。根据药物敏感实验结果将至少对1种药物耐药的归为耐药组,对所有药物均敏感的归为敏感组。收集2组患者的临床资料、治疗史、标本来源、药物敏感状况、结核病发病类型及相关血液检测指标等,采用多因素Logistic回归分析这些因素与结核分枝杆菌耐药发生之间的相关性。结果 AIDS并发肺结核患者标本中共分离培养出83株结核分枝杆菌,以痰液和脑脊液标本所占比例最高,分别为62. 7%和12. 0%。其中58例对所有抗结核药物敏感,25例对至少1种抗结核药物耐药,耐药率为30. 1%。其中单一药物耐药9例,多重耐药16例。单因素Logistic回归分析显示治疗史和发病类型与AIDS并发肺结核患者发生结核分枝杆菌耐药相关(P <0. 05),而性别、是否单纯肺结核、CD4+T淋巴细胞数量和HIV病毒载量等均与结核分枝杆菌耐药性产生无关,P> 0. 05。多因素Logistic回归分析结果显示,血行播散型肺结核是患者发生结核分枝杆菌耐药的危险因素(OR=2. 597,95%CI:1. 903～3. 544)。结论杭州地区AIDS并发肺结核患者对抗结核分枝杆菌的一线药物的耐药率高,CD4+T淋巴细胞数量和HIV病毒载量等均与耐药性产生无关。血行播散型结核是AIDS并发肺结核患者罹患耐药结核的危险因素。
AIM To investigate the drug resistance of Mycobacterium tuberculosis in patients with pulmonary tuberculosis combined with acquired immunodeficiency syndrome( AIDS) via a retrospective study. METHODS The 83 patients with AIDS complicated with pulmonary tuberculosis were treated in our hospital from January 2010 to May 2017. The Mycobacterium tuberculosis isolates were performed drug-sensitive experiments by the proportion method recommended by WHO. The bacterium was determined resistance to the drug by the percentage of drug resistance greater than 1%. According to the results of drug-sensitive test,at least one drug resistant patients were classified as drug resistant group and others were classified as drug sensitive group. Multivariate logistic regression analysis was used to detect the correlation between occurrence of drug resistance of Mycobacterium tuberculosis and treatment history,source of specimen,drug sensitive situation,tuberculosis type and related blood indexes,and so on. RESULTS A total of 83 strains of Mycobacterium tuberculosis were isolated from various samples of AIDS patients complicated with pulmonary tuberculosis. The proportion of sputum and cerebrospinal fluid samples was 62. 7% and 12%,respectively. Among them,58 cases were sensitive to all anti-tuberculosis drugs. The 25 cases had at least one anti-tuberculosis drug resistance and the drug resistance rate was 30. 1%. Of which 9 cases were single drug resistance and 16 cases were multiple drug resistance. Logistic univariate regression analysis showed that treatment history( P < 0. 05) and the incidence of type( P < 0. 05) related to drug resistance of Mycobacterium tuberculosis. Gender,simple pulmonary tuberculosis or not,CD4+T lymphocytes,HIV viral load did not relate to drug resistance of Mycobacterium tuberculosis. Multivariate logistic regression analysis showed that disseminated pulmonary tuberculosis was a risk factor for drug resistance of Mycobacterium tuberculosis( OR = 2. 597,95%CI: 1. 903-3. 544). CONCLUSION The drug resistance rate of first-line drugs against Mycobacterium tuberculosis is high. The number of CD4+T lymphocytes and HIV viral load is not related to drug resistance. Hematogenous pulmonary tuberculosisis is a risk factor for drug-resistant tuberculosis in patients with AIDS.
AIM To investigate the drug resistance of Mycobacterium tuberculosis in patients with pulmonary tuberculosis combined with acquired immunodeficiency syndrome( AIDS) via a retrospective study. METHODS The 83 patients with AIDS complicated with pulmonary tuberculosis were treated in our hospital from January 2010 to May 2017. The Mycobacterium tuberculosis isolates were performed drug-sensitive experiments by the proportion method recommended by WHO. The bacterium was determined resistance to the drug by the percentage of drug resistance greater than 1%. According to the results of drug-sensitive test,at least one drug resistant patients were classified as drug resistant group and others were classified as drug sensitive group. Multivariate logistic regression analysis was used to detect the correlation between occurrence of drug resistance of Mycobacterium tuberculosis and treatment history,source of specimen,drug sensitive situation,tuberculosis type and related blood indexes,and so on. RESULTS A total of 83 strains of Mycobacterium tuberculosis were isolated from various samples of AIDS patients complicated with pulmonary tuberculosis. The proportion of sputum and cerebrospinal fluid samples was 62. 7% and 12%,respectively. Among them,58 cases were sensitive to all anti-tuberculosis drugs. The 25 cases had at least one anti-tuberculosis drug resistance and the drug resistance rate was 30. 1%. Of which 9 cases were single drug resistance and 16 cases were multiple drug resistance. Logistic univariate regression analysis showed that treatment history( P < 0. 05) and the incidence of type( P < 0. 05) related to drug resistance of Mycobacterium tuberculosis. Gender,simple pulmonary tuberculosis or not,CD4+T lymphocytes,HIV viral load did not relate to drug resistance of Mycobacterium tuberculosis. Multivariate logistic regression analysis showed that disseminated pulmonary tuberculosis was a risk factor for drug resistance of Mycobacterium tuberculosis( OR = 2. 597,95%CI: 1. 903-3. 544). CONCLUSION The drug resistance rate of first-line drugs against Mycobacterium tuberculosis is high. The number of CD4+T lymphocytes and HIV viral load is not related to drug resistance. Hematogenous pulmonary tuberculosisis is a risk factor for drug-resistant tuberculosis in patients with AIDS.
引文
[1]刘敏,李奇穗,谭顺,等.艾滋病合并结核病患者结核分枝杆菌原发耐药的回顾性研究[J].中华传染病杂志,2017,35(5):278.
[2]GAO G J,LIAN L,SUN Y,et al. Drug resistance characteristics of Mycobacterium tuberculosis isolates to four first-line anti-tuberculous drugs from tuberculosis patients with AIDS in Beijing,China[J].Int J Antimicrob Agents,2015,45(2):124.
[3]MESFIN Y M,HAILEMARIAM D,BIADGILIGN S,et al. Association between HIV/AIDS and multi-drug resistance tuberculosis:a systematic review and meta-analysis[J]. Plo S One,2014,9(1):e82235.
[4]中华医学会感染学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志,2015,8(5):385.
[5] World Health Organization. Anti-tuberculosis drug resistance in the world:fourth global report[R]. Geneva:WHO,2008.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485.
[7]黄建英,钟球,周琳,等.中国肺结核治疗失败影响因素的Meta分析[J].中华疾病控制杂志,2014,18(2):102.
[8]ZIGNOL M,GW VAN,D FALZON,et al. Surveillance of anti-tuberculosis drug resistance in the world:an updated analysis,2007-2010[J]. Bull World Health Organ,2012,90(2):111.
[9]王瑞,殷雨天,张鹏,等. 395例痰结核菌培养阳性肺结核患者耐药情况分析[J].中国实验诊断学,2015,19(8):1343.
[10]ZHAO Y,XU S,WANG L,et al. National survey of drug-resistant tuberculosis in China[J]. N Engl J Med,2012,366(23):2161.
[11]尹柯,杨励,李圆菲,等. CD4+CD25+Foxp3+T淋巴细胞抑制耐药肺结核患者机体细胞免疫研究[J].中国感染控制杂志,2012,11(5):328.
[12] KESHAVJEE S,FARMER P E. Tuberculosis,drug resistance,and the history of modern medicine[J]. N Engl J Med,2012,367(10):931.
[13]范大鹏,陈光,吴盛海,等. 723例结核病住院患者结核分枝杆菌耐药性分析[J].浙江预防医学,2013,25(12):42.
[14]王坚杰,周美兰,段琼红,等. 2010年湖北省武汉市第5次结核病流行病学抽样调查分析[J].中华疾病控制杂志,2014,18(4):326.
[2]GAO G J,LIAN L,SUN Y,et al. Drug resistance characteristics of Mycobacterium tuberculosis isolates to four first-line anti-tuberculous drugs from tuberculosis patients with AIDS in Beijing,China[J].Int J Antimicrob Agents,2015,45(2):124.
[3]MESFIN Y M,HAILEMARIAM D,BIADGILIGN S,et al. Association between HIV/AIDS and multi-drug resistance tuberculosis:a systematic review and meta-analysis[J]. Plo S One,2014,9(1):e82235.
[4]中华医学会感染学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志,2015,8(5):385.
[5] World Health Organization. Anti-tuberculosis drug resistance in the world:fourth global report[R]. Geneva:WHO,2008.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485.
[7]黄建英,钟球,周琳,等.中国肺结核治疗失败影响因素的Meta分析[J].中华疾病控制杂志,2014,18(2):102.
[8]ZIGNOL M,GW VAN,D FALZON,et al. Surveillance of anti-tuberculosis drug resistance in the world:an updated analysis,2007-2010[J]. Bull World Health Organ,2012,90(2):111.
[9]王瑞,殷雨天,张鹏,等. 395例痰结核菌培养阳性肺结核患者耐药情况分析[J].中国实验诊断学,2015,19(8):1343.
[10]ZHAO Y,XU S,WANG L,et al. National survey of drug-resistant tuberculosis in China[J]. N Engl J Med,2012,366(23):2161.
[11]尹柯,杨励,李圆菲,等. CD4+CD25+Foxp3+T淋巴细胞抑制耐药肺结核患者机体细胞免疫研究[J].中国感染控制杂志,2012,11(5):328.
[12] KESHAVJEE S,FARMER P E. Tuberculosis,drug resistance,and the history of modern medicine[J]. N Engl J Med,2012,367(10):931.
[13]范大鹏,陈光,吴盛海,等. 723例结核病住院患者结核分枝杆菌耐药性分析[J].浙江预防医学,2013,25(12):42.
[14]王坚杰,周美兰,段琼红,等. 2010年湖北省武汉市第5次结核病流行病学抽样调查分析[J].中华疾病控制杂志,2014,18(4):326.