应用噬菌体生物扩增法对HIV/TB双重感染患者抗结核药耐药性分析研究

摘要

目的 利用噬菌体生物扩增法(PhaB)分析人类免疫缺陷病毒(HIV)合并结核病(TB)双重感染患者的结核分枝杆菌的耐药状况,优化防治对策.方法 运用PhaB法对重庆市第九人民医院收治的112例HIV/TB双重感染患者(HIV/TB组)做TB菌的药敏检测,并与208例单纯肺结核患者(单纯TB组)的药敏检测做对比分析.结果 HIV/TB组的抗TB药耐药率要比单纯TB组低,HIV/TB双重感染患者5种常见抗TB药物的耐药率分别为异烟肼(INH) 7.14％、吡嗪酰胺(PZA) 7.14％、利福平(RFP) 5.36％、链霉素(SM) 5.36％、乙胺丁醇(EMB)4.46％,与单纯TB组患者比较(RFP 17.31％、INH 13.46％、PZA11.54％、EMB 10.58％、SM 9.62％),HIV/TB组RFP的耐药率低于单纯TB组,差异有统计学意义(P＜0.05),其他4种抗TB药耐药率与单纯TB组比较差异无统计学意义(P＞0.05),与绝对浓度法结果符合率分别为INH 96.4％、RFP 98.2％、PZA 96.4％、EMB 93.8％和SM 96.4％.结论 本地区HIV/TB双重感染患者结核分枝杆菌对RFP耐药率较普通肺结核患者低,与该类患者良好的服药依从性相关.PhaB测定所需时间短,操作简便,不需特殊仪器设备,可作为结核分枝杆菌耐药性的快速筛选方法.%Objective To analyze the drug resistance status of mycobacterium tuberculosis in patients with double immunization of human immunodeficiency virus (HIV) and tuberculosis (TB) by phage bioassay (PhaB),and to optimize the control strategy.Methods One hundred and twelve cases of HIV/TB infected patients.in Chongqing Ninth People's Hospital were treated with PhaB method,and the drug susceptibility testing results were compared with 208 cases of simple pulmonary tuberculosis patients.Results The anti-tuberculosis drug resistance rate of HIV/TB patients was lower than that of simple pulmonary tuberculosis patients.The resistance rates of 5 common anti-tuberculosis drugs in HIV/TB patients were 7.14％ of isoniazid (INH),7.14％ of pyrazinamide (PZA),5.36 ％ of rifampicin(RFP) streptomycin(SM),and 4.46 ％ of ethambutol (EMB),compared with simple pulmonary tuberculosis(resistance rates of RFP were 17.31％,IN H 13.46 ％,PZA 11.54 ％,EMB 10.58 ％,SM 9.62 ％),RFP resistance rate of HIV/TB infected patients was lower(P＜0.05).There was no significant difference between two groups in the other four anti-tuberculosis drug(P＞0.05).The coincidence rate with the absolute concentration method were INH 96.4％,RFP 98.2％,PZA 96.4％,EMB 93.8％ and SM 96.4％,respectively.Conclusion The resistance rate of mycobacterium tuberculosis to RFP in patients with HIV/TB infection in this region is lower than that in patients with common pulmonary tuberculosis,which is related to the good medication compliance of these patients.PhaB has the characteristic of fast,simple,without special equipment,it can be used as a rapid screening of mycobacterium tuberculosis drug resistance method.