漳州市复治耐药肺结核的临床和病原学分析

目的了解漳州市复治耐药肺结核的临床特征和病原学情况。方法经对复治肺结核患者的晨痰、胸液进行分枝杆菌培养、鉴定和抗结核药物敏感性试验。结果11例复治肺结核患者中，2例规则抗结核治疗，9例抗结核药物未满疗程。均为继发性肺结核，8例为结核分枝杆菌感染，1例“复治肺结核”为非结核分枝杆菌病。8例复治培阳肺结核患者均有不同程度耐药。耐多药5例，耐药种类3—10种。所有耐药菌株中发现2株为利福平依赖菌。结论复治肺结核多表现有空洞、肺毁损，易继发感染、合并糖尿病、肺心病。不规则用药是导致复治和耐药的最常见原因。耐药率为72．7％，肺结核耐多药率达62．5％。对漳州复治肺结核患者有必要广泛开展结核分枝杆菌培养、鉴定和药物敏感性试验，更利于医疗、防疫人员循证科学施治，对预防耐药肺结核发生和减少耐药肺结核的社区传播具有重要意义。

Clinical characteristics and pathogenic analysis of retreated drug-resistant pulmonary tuberculosis in Zhangzhou city

Objective To understand pathogenic state and clinic characteristics of retreatment drug-resistant pulmonary tuberculosis in Zhangzhou, Methods The early-morning sputum, or pleural effusion of retreatment pulmonary tuberculous patients were cultured and identified by use of BacT/ALERT and BACTECT mycobacterial growth indicator tube 960 systems. Then anti-tuberculous drug susceptibility was tested. The study included eleven patients who were diagnosed as retreated pulmonary tuberculosis. In all, two patients were treated regularly and nine patients refused to take orally anti-tuberculous drugs before the end of the treatment period. They were all suffered from secondary pulmonary tuberculosis. Results The concomitant syndrome was followed as empty （6 cases）, impairment of lung （ 5 cases ）, respiratory failure （ 5 cases ）, lung infection （ 4 cases）, pulmonary pleurorrhea （ 1 case）, chronic cot pulmonale （ 3 cases）, and diabetes （3 cases）. Two patients showed negative mycobacterium tuberculosis culture. Eight patients were infected by mycobacterium tuberculosis and one case was identified as non-Mycobacterium tuberculosis by bacterial culture. Eight patients with positive mycobacterium tuberculosis culture manifested drngs-rcsistance to some extent. Five cases were multi-drug resistant tuberculosis（ MDR-TB, meaning resistance to at least isoniazid and rifampin）. Those were resistant to three to ten anti-tuberculous drugs. Two strain were rifampin-dependent bacillus. Conclusion Retreated of pulmonary tuberculosis often manifests empty or lung damage and can be easily resulted in secondary infection, chronic pulmonary heart disease, or diabetes. The occurrence of retreated TB with resistance to anti-tuberculous drugs mainly resuits from irregular use of medication. The drug resistance rate is 72.7%. The multi-drug resistance rate of pulmonary tuberculosis is 62. 5 %. It is indispensable for the culture,identification, or anti-tuberculous drug-susceptibility test of Mycobacterium tubercul