HIV/TB双重感染与HIV阴性结核病结核分枝杆菌耐多药现状分析

目的探讨艾滋病病毒（HIV）/结核病（TB）双重感染的结核分枝杆菌耐多药现状,为HIV/TB双重感染的耐多药结核病的防治,制定合理的预防措施及个体化的治疗方案提供科学依据。方法 2004年1月至2008年12月,在南宁市第四人民医院住院的痰结核分枝杆菌培养阳性的结核病患者,按HIV抗体检测结果分为HIV抗体阳性结核病组（HIV/TB双重感染组）和HIV抗体阴性结核病组,对两组检出的结核分枝杆菌进行菌种鉴定及耐药检测（INH、RFP、EMB、SM）,并比较两组结核分枝杆菌的总耐药和多耐药发生率,初始及获得性耐药、耐多药的发生率。结果 HIV/TB双重感染组的149株结核分枝杆菌,发生耐药的61株,总耐药率40.94%,总耐多药率为18.79%;初始耐药率为40.30%,耐多药率为18.66%;获得性耐药率为46.67%,获得性耐多药率为20.0%。HIV抗体阴性结核病组的2152株结核分枝杆菌,总耐多药、初始耐多药及获得性耐多药率分别为15.94%、8.25%、32.36%。结果显示,HIV抗体阳性组初始耐多药率较HIV抗体阴性组高,两者差异有统计学意义（P〈0.01）。结论 HIV/TB双重感染的结核分枝杆菌,对药物的耐药性流行水平有上升趋势,同时多重耐药株增多。结核分枝杆菌耐药性的监测结果 ,是指导临床治疗用药的重要依据。

Analysis of multidrug-resistant mycobacterium tuberculosis in TB patients co-infected with HIV and in HIV negative TB patients

Objective To investigate multidrug-resistant mycobacterium tuberculosis in TB patients co-infected with HIV and HIV negative TB patients,and provide scientific basis for prevention and individualized treatment of TB patients co-infected with HIV. Methods Clinical and laboratory data were retrospectively analyzed in TB patients hospitalized in the Nanning 4th Hospital from January 2004 to December 2008. The patients were divided into 2 groups：HIV positive and HIV negative group,and the strain identifications and the result of drug susceptibility tests （INH,RFP,EMB,SM） were analyzed. Results A total of 149 strains of mycobacterium tuberculosis（MTB）（including 61 drug-resistant strains） were isolated from HIV positive patients. The rate of total drug resistance was 40.94%,and the rate of total multi-drug resistance（MDR） was 18. 79%. The rates of initial drug resistance and initial MDR were 40.30% and 18.66%,respectively. The rates of acquired drug resistance and acquired MDR were 46.67% and 20.0%,respectively. In the HIV negative group （2152 cases of positive MTB culture ）,the rate of total MDR,initial MDR and acquired MDR were 15.94%,8.25% and 32.36%,respectively. These data indicated that the rate of initial MDR in the HIV positive group was significantly higher than in the HIV negative group （P0.01）. Conclusions The tendency of multidrug-resistance of mycobacterium tuberculosis in TB patients co-infected with HIV has increased in the past 5 years. Multiple resistance to two or more antibiotics is frequent. Long-term monitoring of multidrug-resistance of MTB is important for guiding clinical treatment of TB patients co-infected with HIV.