关键词: 结核, 脑膜, 分枝杆菌, 结核, 微生物敏感性试验, CD4淋巴细胞计数

Abstract: Objective To retrospectively analyze drug susceptibility test and strain identification of Mycobacterium tuberculosis in cerebrospinal fluid, as well as investigate the results of CD4⁺ T lymphocyte counts in peri-pheral blood from the patients with tuberculous meningitis (TBM), to provide a basis for early intervention of tuberculous meningitis. Methods Clinical data of 95 cases with the recorded drug susceptibility test of Mycobacterium tuberculosis were collected from tuberculous meningitis department of Public Health Medical Center on Chongqing during Jan. 3, 2011 to Nov. 27, 2013, in which there were 52 male and 43 female; 73 cases of initial treatment, 21 cases of retreatment (excluding 1 case infected with non-tuberculosis mycobacterium); 16 cases with positive HIV antibody by clinical blood detection. The Chi-square test was used to analyze the results of drug susceptibility test (including total 11 kinds of drugs: streptomycin (Sm), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), amikacin, ofloxacin, capreomycin, ethionamide, pasiniazide (PAIN), rifapentine (Rft), sodium aminosalicylate), strain identification, and the counts of CD4⁺ T lymphocyte in peripheral blood in the early stage of treatment. Resistance characteristics and the influencing factors of either resistance or count were analyzed, and when P-values <0.05, the difference between two means was considered statistically significant.  Results (1)The drug susceptibility test and species identification: 1 case (1/95, 1.1％) of non-tuberculosis mycobacterium was resistant to 11 kinds of anti-tuberculosis drugs; Of 94 cases (94/95, 98.9％) of Mycobacterium tuberculosis complex, 40 cases (42.6%) had varying degrees of resistance to 11 kinds of anti-tuberculosis drugs, MDR-TB was 12.8% (12/94), and XDR-TB was 1.1% (1/94). (2)Drug-resistant types: 9.6％(9/94) cases were resistant to single drug; 16.0％(15/94) cases were resistant to two kinds of drugs; 2.1% (2/94) cases were resistant to three kinds of drugs, and 14.9% (14/94) were resistant to more than three kinds of drugs. (3)The top six rank of drug resistances: Sm 26.6% (25/94)＞INH 23.4% (22/94)＞RFP 18.1% (17/94)＞PAIN 16.0% (15/94)＞EMB and Rft 14.9%(14/94). (4) The counts of CD4⁺ T lymphocytes in peripheral bloods from 11 cases (11/94, 11.7％) with TBM were within the normal range. The gender (male:90.2%(46/51), female:86.0%（37/43）), initial treatment 90.4% (66/73) or retreatment 81.0% (17/21) did not effect on the count (χ²-values were 7.76, 7.44 respectively, P＞0.05). The counts of CD4⁺ T lymphocytes in the cases with HIV antibody-positive TBM 100.0%(16/16) were significantly lower than those with HIV antibody-negative TBM 85.9%(67/78) (χ²-value was 34.21, P<0.01). Conclusion Ninety-four TBM cases with either initial treatment or retreatment showed high drug-resistant trend, and their counts of CD4⁺ T lymphocyte in peripheral blood were generally low, especially the TBM cases complicated with AIDS.

Key words: Tuberculosis, meningeal, Mycobacterium tuberculosis, Microbial sensitivity tests, CD4 lymphocyte count