HIV/AIDS合并结核病患者196株结核分枝杆菌耐药分析

目的 探讨人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)合并结核病患者结核分枝杆菌菌株的耐药情况.方法 收集成都市公共卫生临床医疗中心2012年1月至2015年12月住院治疗的HIV/AIDS合并结核病初治患者196例,分析AIDS合并活动性结核病(包括肺结核及肺外结核)患者的痰液/组织液/纤冲液及病理组织送检分枝杆菌培养出的结核分枝杆菌菌株的耐药情况,采用BACTEC MGIT960鉴定系统进行菌型鉴定,960分枝杆菌培养系统进行药敏实验.结果 共培养出结核分枝杆菌菌株196株,发生结核分枝杆菌总体耐药率为26.02％;将196例AIDS合并结核病患者按CD4+T淋巴细胞计数不同分为大于100个/μL、≤100个/μL两组,比较两组患者结核分枝杆菌菌株对4种一线抗结核药物的耐药状况,发现两组患者结核分枝杆菌菌株对一线抗结核药物耐药率比较,差异无统计学意义(P＞0.05),一线抗结核药耐药发生率由高到低依次为:异烟肼、利福平、链霉素、乙胺丁醇.两组患者结核分枝杆菌菌株对5类耐药结核耐药率比较,差异无统计学意义(P＞0.05).结论 AIDS合并结核病初始患者耐药率与我国结核平均初始耐药水平一致,HIV/AIDS合并结核病患者的结核耐药性与CD4+T淋巴细胞计数水平高低无相关性.

Analysis on drug resistance of 196 strains of Mycobacterium tuberculosis in patients with HIV/AIDS complicating tubercolosis

Objective To study the drug resistance situation of Mycobacterium tuberculosis strains isolated from the patients with HIV/AIDS complicating tuberculosis (TB).Methods One hundred and ninety-six inpatients with AIDS complicating TB in our hospital from January 2012 to December 2015 were collected.The drug resistance situation of Mycobacterium tuberculosis strains cultured from sputum/tissue fluid/fiber liquid and pathological tissue submitted samples in the patients with AIDS complicating active TB was analyzed.The BACTEC MGIT960 systems was adopted to perform the bacterial identification.The drug sensitivity test was conducted by using 960 culture testing system.Results One hundred and ninety-six strains of Mycobacterium tuberculosis were cultured,the total drug resistance rate of Mycobacterium tuberculosis was 26.02％.These cases were divided into the ＞100/μL and ≤100/μL groups according to different CD4+ T cells count.The drug resistance situation of Mycobacterium tuberculosis to 4 kinds of first line anti-TB drugs were compared between these two groups.The comparison results found that the resistance rate of Mycobacterium tuberculosis strains to the first line anti-TB drugs had no statistical difference between the two groups (P＞0.05).The resistance rates of first line anti-TB drugs from high to low were isoniazid,rifampicin,streptomycin and ethambutol.The drug resistance rate of Mycobacterium tuberculosis strains to 5 types of drug resistant TB had no statistical difference(P＞0.05).Conclusion The drug resistance rate in the initial patients with HIV complicating TB is consistent with the average initial drugresistance level of TB patients in our country.The TB drug resistance rate in the patients with HIV complicating TB has no correlation with CD4+ T cells count.