关键词: 结核, 肺, CD4淋巴细胞计数, 革兰阴性菌, 微生物敏感性试验

Abstract: Objective  Investigate on sputum pathogenic bacteria and drug sensitivity test,blood CD4 cell count and in the multi-drug resistant pulmonary tuberculosis patients (multi-drug resistant pulmonary tuberculosis, MDR-PTB). Methods A retrospective analysis of 489 cases of CD4 cell count in patients with MDR-PTB and sputum isolation and identification of bacteria and its drug sensitivity test of the main pathogenic bacteria results by, non pathogenic bacteria are divided into pathogen group 206 cases, non pathogenic bacteria group with 283 cases. The measurement data in “x±s” said the count data expressed in percentage. Correlation between the two groups were compared using U test, χ² test, t test, with P<0.05 as the difference had statistical significance.  Results CD4 total cell detection results for (438±258)/μl, non pathogenic bacteria group (514±273)/μl, pathogen group (340±194)/μl, there was significant difference between two groups (U=8.23, P<0.01). Pathogenic bacteria group of 244 strains of bacteria were isolated, gram negative bacilli accounted for 50.4% (123/244), including pneumonia gram Lei Bojun, Enterobacter cloacae, Pseudomonas aeruginosa, Bauman-hemolytic Acinetobacter and Escherichia coli is ranked in the top 5; fungi accounted for 25.8% (63/244), Candida albicans is the main; gram positive cocci accounted for 23.8% (58/244), with Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus haemolyticus based. ESBLs bacteria detection rate of 5.3% (13/244); methicillin-resistant Staphylococcus aureus detection rate was 10.7% (26/244). In CD4 <400/L interval of pathogenic bacteria infection in 154 cases, accounting for pathogen group 74.8% (154/206). Thirty-five cases of single fungus, 3 cases of CD4 is less than or equal to 200/μl、 12 cases of 201/μl≤CD4≤400/μl，10 cases of 401/μl≤CD4≤ 600/μl, 10 cases of CD4 >600/μl. Bacteria and fungi in 28 cases, 17 cases of CD4 is less than or equal to 200/μl, 7 cases of 201/μl ≤CD4≤400/μl, 4 cases were dispersed in the other interval. The first 5 gram negative bacilli to amikacin, gentamycin, levofloxacin sensitive rate above 50.0%, except Pseudomonas aeru-ginosa to carbapenem sensitive rate was 100.0%; leather sensitive rate of gram-positive cocci to daptomycin, linezolid, vancomycin was 100%, resistant to penicillin, ampicillin ampicillin, ceftriaxone, shubatan rate in more than 60.0%. Conclusion Respiratory tract infections in patients with MDR-PTB in CD4 cells in low, CD4 is less than or equal to 400/L interval occurred bacteria, bacterial fungal infection, gram negative bacilli, but different pathogenic bacteria drug sensitivity of different, clinical attention should be paid to improving the immunity function of patients, accor-ding to etiological examination and the results of drug sensitive test, screening effective antibiotics.

Key words: Tuberculosis, pulmonary, CD4 lymphocyte count, Gram-negative bacteria, Microbial sensitivity tests