重症肺结核患者病原学阳性率及利福平耐药结果分析

doi:10.19982/j.issn.1000-6621.20240165

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (9): 1050-1055.doi: 10.19982/j.issn.1000-6621.20240165

重症肺结核患者病原学阳性率及利福平耐药结果分析

耿子妹, 王潮虹, 龙嗣博, 郑迈克, 施亦衡, 孙勇, 赵艳, 王桂荣()

首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所检验科,北京 101149

收稿日期:2024-04-29 出版日期:2024-09-10 发布日期:2024-08-30
通信作者: 王桂荣, Email: wangguirong1230@ccmu.edu.cn
基金资助:
北京市高层次公共卫生技术人才项目(2022-3-040);北京市通州区科技计划项目(KJ2023CX038)

Analysis of bacteriological positivity and rifampicin resistance in patients with severe pulmonary tuberculosis

Geng Zimei, Wang Chaohong, Long Sibo, Zheng Maike, Shi Yiheng, Sun Yong, Zhao Yan, Wang Guirong()

Department of Clinical Laboratory,Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China

Received:2024-04-29 Online:2024-09-10 Published:2024-08-30
Contact: Wang Guirong, Email: wangguirong1230@ccmu.edu.cn
Supported by:
Beijing Public Health Experts Project(2022-3-040);Beijing Tongzhou Municipal Science and Technology Commission(KJ2023CX038)

摘要/Abstract

摘要：

目的: 分析重症肺结核患者病原学阳性率及利福平耐药情况,为临床治疗重症肺结核提供参考。方法: 选取2023年1—12月首都医科大学附属北京胸科医院收治的临床诊断为肺结核的369例患者为研究对象,其中145例为重症肺结核,224例为轻症肺结核。分析患者痰液抗酸杆菌染色涂片法(涂片法)、BACTEC MGIT 960液体培养法(MGIT 960法)和GeneXpert MTB/RIF(Xpert法)的阳性率及对利福平的耐药情况。结果: 重症肺结核患者中,涂片法、培养法和Xpert法的阳性率及病原学总阳性率分别为47.41%(55/116)、68.75%(77/112)、85.82%(115/134)和80.69%(117/145),明显高于轻症患者[29.44%(63/214)、53.17%(109/205)、68.35%(149/218)、71.43%(160/224)],差异均有统计学意义(χ²=10.580,P=0.001;χ²=7.250,P=0.007;χ²=12.512,P<0.001;χ²=4.034,P=0.045)。Xpert法检测阳性的重症与轻症肺结核患者利福平耐药率分别为11.30%(13/115)和8.05%(12/149),差异无统计学意义(χ²=0.800,P=0.371)。Xpert法阳性的重症肺结核中,复治患者利福平耐药率为24.24%(8/33),高于初治患者[6.10%(5/82)],差异有统计学意义(χ²=7.727,P=0.005)。结论: 相较于轻症患者,重症肺结核患者的病原学阳性率较高,且Xpert法阳性率最高。重症与轻症肺结核间利福平耐药情况无差异,而重症肺结核复治患者利福平耐药率明显高于初治患者。

关键词: 结核,肺, 微生物学技术, 抗药性, 细菌

Abstract:

Objective: To assess the bacteriological positivity rate and rifampicin resistance in sputum samples from patients with severe pulmonary tuberculosis. Methods: A retrospective analysis was conducted on 369 cases of pulmonary tuberculosis admitted to Beijing Chest Hospital, Capital Medical University, between January and December 2023, including 145 severe and 224 non-severe cases. The positive detection rates of Mycobacterium tuberculosis (MTB) in sputum samples were evaluated using acid-fast staining smear microscopy (smear), BACTEC MIGT 960 culture (culture), and Xpert MTB/RIF (Xpert). Rifampicin resistance was also assessed. Results: In severe pulmonary tuberculosis, the positive rates for smear, culture, and Xpert tests, as well as the overall bacteriological positivity rate, were 47.41% (55/116), 68.75% (77/112), 85.82% (115/134), and 80.69% (117/145), respectively. In non-severe cases, these rates were 29.44% (63/214), 53.17% (109/205), 68.35% (149/218), and 71.43% (160/224), respectively. The differences between severe and non-severe cases were statistically significant(χ²=10.580,P=0.001;χ²=7.250,P=0.007;χ²=12.512,P<0.001;χ²=4.034,P=0.045).There was no significant difference in rifampicin resistance rates between patients with severe pulmonary tuberculosis and those with non-severe cases (11.30% (13/115) vs. 8.05% (12/149);χ²=0.800, P=0.371). However, rifampicin resistance rates were higher in previously treated cases compared to new cases among Xpert-positive patients (24.24% (8/33) vs. 6.10% (5/82); χ²=7.727,P=0.005). Conclusion: Patients with severe pulmonary tuberculosis exhibited a higher bacteriological positivity rate; however, there was no significant difference in rifampicin resistance rates between severe and non-severe cases. Rifampicin resistance rates were notably higher in previously treated cases compared to newly diagnosed cases.

Key words: Tuberculosis, pulmonary, Microbiological techniques, Drug resistance, bacterial

中图分类号:

R521
R446.5

耿子妹, 王潮虹, 龙嗣博, 郑迈克, 施亦衡, 孙勇, 赵艳, 王桂荣. 重症肺结核患者病原学阳性率及利福平耐药结果分析[J]. 中国防痨杂志, 2024, 46(9): 1050-1055. doi: 10.19982/j.issn.1000-6621.20240165

Geng Zimei, Wang Chaohong, Long Sibo, Zheng Maike, Shi Yiheng, Sun Yong, Zhao Yan, Wang Guirong. Analysis of bacteriological positivity and rifampicin resistance in patients with severe pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2024, 46(9): 1050-1055. doi: 10.19982/j.issn.1000-6621.20240165

图/表 2

参考文献 19

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特征	重症肺结核(145例)	轻症肺结核(224例)	χ²值	P值
性别			2.931	0.087
男性	108(74.48)	148(66.07)
女性	37(25.52)	76(33.93)
年龄组(岁)			15.047	0.058
10~19	1(2.22)	6(2.68)
20~29	12(8.28)	27(12.05)
30~39	15(10.34)	16(7.14)
40~49	15(10.34)	23(10.27)
50~59	22(15.17)	41(18.30)
60~69	17(11.72)	43(19.20)
70~79	28(19.31)	39(17.41)
80~89	27(18.62)	25(11.16)
90~99	8(5.52)	4(1.79)
合并症
糖尿病	63(43.45)	93(41.52)	0.134	0.714
高血压	27(18.62)	81(36.16)	13.081	<0.001
冠心病	21(14.48)	48(21.43)	2.793	0.095
类风湿关节炎	3(2.07)	7(3.13)	-^a	0.746
尘肺	4(2.76)	2(0.90)	-^a	0.216
脑梗	14(9.66)	18(8.04)	0.291	0.589
帕金森	0(0.00)	2(0.90)	-	-
恶性肿瘤术后	5(3.45)	18(8.04)	3.169	0.075

检测方法	重症肺结核				轻症肺结核
检测方法	初治(107例)	复治(38例)	χ²值	P值	初治(136例)	复治(88例)	χ²值	P值
涂片法	42(51.22)	13(38.24)	1.625	0.202	49(37.40)	14(16.87)	10.316	0.001
培养法	51(65.38)	26(76.47)	1.355	0.244	75(61.98)	34(40.48)	9.211	0.002
Xpert法	82(85.42)	33(86.84)	0.045	0.831	92(69.70)	57(66.28)	0.423	0.515

重症肺结核患者病原学阳性率及利福平耐药结果分析

Analysis of bacteriological positivity and rifampicin resistance in patients with severe pulmonary tuberculosis

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