结核病3种实验诊断方法比较与分枝杆菌耐药性分析

目的 比较结核病3种实验诊断方法,分析目前深圳市分枝杆菌耐药情况.方法 统计2009～2010年深圳市第三人民医院临床确诊结核病患者痰标本涂片镜检、培养和PCR检测结果,并对分枝杆菌菌种及对治疗药物耐药情况进行统计分析.结果 共有640例资料齐全的结核病确诊病例入选,其中肺结核537例、结核性胸膜炎82例、结核性脑膜炎21例,分枝杆菌涂片镜检阳性率分别为44.1%、5.3%和13.3%,分枝杆菌培养法阳性率分别为59.9%、12.9%和30.0%,PCR检测阳性率分别为52.2%、16.7%和26.3%.经分枝杆菌菌种鉴定,人型结核分枝杆菌占67.0%、牛型结核分枝杆菌占16.8%、非结核分枝杆菌占16.2%,人型结核分枝杆菌对利福平、异烟肼、乙胺丁醇、链霉素的耐药率分别为16.4%、14.8%、4.7%和15.6%.结论 目前结核病实验诊断方法主要有涂片镜检、培养和PCR检测,病原菌以人型结核分枝杆菌为主,对3种主要抗结核药物的耐药率较高.另外,菌阴结核约占40%,目前对菌阴结核、活动性结核与陈旧性结核的诊断和鉴别诊断困难,期待新的方法.

Comparison of three methods in the detection of tuberculosis and analysis of drug resistance in clinical isolates of Mycobacterium

Objective To compare of three methods in tuberculosis detection and analyze the drug resistance of Mycobacterium isolats.Methods The results of smear-microscopy,Mycobacterium culture,and PCR detection of patients with definite diagnosis of tuberculosis in Shenzhen Third People’s Hospital between 2009 and 2010 were analyzed,including the species of Mycobacterium and drug resistance.Results Total 640 hospitalized patients with well medical records were enrolled in this study,including 537 cases of pulmonary tuberculosis,82 of tuberculosis pleurisy and 21 of tuberculosis meningitis,the positive rates of smear-microscopy of whom were 44.1%,5.3% and 13.3%,of Mycobacterium-culture were 59.9%,12.9% and 30.0%,and of PCR detection were 52.2%,16.7% and 26.3% respectively.Species of Mycobacterium were made up with 67.0% of Mycobacterium tuberculosis,16.8% of Mycobacterium bovis and 16.2% of Mycobacterium other than tuberculosis,which were confirmed by Mycobacterium isolates identification.The drug resistance of Mycobacterium tuberculosis to Rifampin,Isoniazid,Ethambutol and Streptomycin were 16.7%,15.1%,4.8% and 15.9% respectively.Conclusion The main laboratory diagnostic methods of tuberculosis were smear-microscopy,Mycrobacterium-culture and PCR detection at present in Shenzhen,and most common pathogens that cause tuberculosis were Mycobacterium tuberculosis with high level drug resistance to three mainly used anti-tuberculosis drugs presently.In addition,about 40% tuberculosis patients were negative with Mycobacterium,bringing difficulties to identify active tuberculosis and old inactive tuberculosis,indicating that new and advanced diagnostic methods should be further researched.