艾滋病合并腹腔结核性脓肿的结核分枝杆菌耐药性分析

摘要

Objective To investigate the culture and drug-resistant detection of Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS and abdominal tuberculous abscesses, to analyze the relationship between the cellular immune function of AIDS patients and the positive rate of MTB culture and the rate of drug resistance, and to provide the basis for the formulation of anti-tuberculosis treatment. Methods A total of 262 cases of patients with abdominal tu-berculous abscesses, who admitted to Department of General Surgery and Oncology of Public Health Clinical Center of Chengdu between January 2010 and December 2016 were enrolled, including 96 patients with AIDS (HIV+group) and 166 without AIDS (HIV- group). The pus and wall tissue of abscesses were collected by abscesses incision drainage through open surgery or laparoscope, or ultrasound-guided percutaneous tube drainage. Improved Rothe media BACTBC MGIT960 and broth microdilution method were used for MTB culture and drug-resistant detection. HIV+group was classified into the three subgroups according to CD4+T cell count as following:groupⅠ(<100 cells/μL) of 19 patients, groupⅡ(100-200 cells/μL) of 46 patients, and groupⅢ(>200 cells/μL) of 31 patients. The positive culture rates and drug-resistant condition of MT in different immunity of patients with HIV/AIDS and abdominal tuberculous ab-scesses were compared. Results A total of 94 (35.9%) cases of MTB, including 34 (36.2%) drug-resistant ones, were separated from all 262 samples;the positive culture rate of MTB in the HIV+group was 45.8%, which was significantly higher than 30.1%in the HIV-group (P<0.05);the drug-resistant rates in HIV+group and HIV-group were respectively 38.6%and 34.0%, and there is no statistically significant difference between the two groups (P>0.05);the drug-resistant conditions of first-line anti-tuberculosis drugs in HIV+group and HIV-group were as following:28.1%/30.1%of isonia-zid (INH), 18.7%/16.9% of rifampicin (RFP), 37.5%/34.6% of streptomycin (SM), and 12.5%/15.3% of ethambutol (EMB), respectively;the drug-resistant conditions of second-line anti-tuberculosis drugs in HIV+group and HIV-group were as following:31.2%/26.4%of capreomycin (CPM), 21.8%/25.2%of ofloxacin (OFX), 18.7%/15.9%of kanamycin (KM), and 6.2%/8.1%of protionamide (PTO), respectively;the positive culture rates of MTB in HIV+groupⅠ, groupⅡand groupⅢwere 31.6%, 58.7%, 35.5%, respectively, and the drug-resistant rate were 50.0%, 40.7%, 27.3%, respective-ly (P>0.05). Conclusion The positive culture rate of MT in the HIV+group is more than the HIV-group, but there is no statistically significant difference in drug-resistant rate between the two groups. The statistical correlation between CD4+T cell count and MTB culture and drug-resistant rate in patients with HIV/AIDS and abdominal tuberculous abscesses isn''t found. Therefore, the culture and drug-resistant detection of MTB are conducive to formulating a reasonable individual-ized anti-tuberculosis program and achieving an ideal prognosis.%目的 对艾滋病(AIDS)合并腹腔结核性脓肿进行结核分枝杆菌(MTB)培养及耐药检测,并分析AIDS患者细胞免疫功能状态与MTB培养阳性率及耐药率的关系,为制定抗痨治疗方案提供依据.方法 选取2010年1月至2016年12月成都市公共卫生临床医疗中心普通外科暨肿瘤外科收治的腹腔结核性脓肿患者262例,其中AIDS合并腹腔结核性脓肿(HIV+组)96例、未合并AIDS的腹腔结核性脓肿(HIV-组)166例.以开腹脓肿切开引流术、腹腔镜下脓肿切开引流术、超声引导下腹腔脓肿穿刺置管引流术三种方式采集腹腔结核性脓肿的脓液或/和脓腔壁组织送检.采用罗氏改良培养基BACTBC MGIT960及微孔板比例法进行MTB培养和耐药检测.以术前CD4+T淋巴细胞计数作为分层依据,将HIV+组分为HIV+Ⅰ组(<100 cells/μL)19例、HIV+Ⅱ组(100~200 cells/μL)46例、HIV+Ⅲ组(>200 cells/μL)31例,分析不同免疫功能状态下HIV/AIDS合并腹腔结核性脓肿的MTB培养阳性率及耐药情况.结果 262例腹腔结核性脓肿共培养MTB 94株(35.9%),其中耐药菌株34株(36.2%);HIV+Ⅱ组患者的MTB培养阳性率为45.8%,高于HIV-组的30.1%,差异有统计学意义(P<0.05);HIV+组患者的耐药率为38.6%,与HIV-组的34.0%比较,差异无统计学意义(P>0.05);HIV+组与HIV-组患者抗痨一线药物耐药情况分别为异烟肼28.1%/30.1%、利福平18.7%/16.9%、链霉素37.5%/34.6%、乙胺丁醇12.5%/15.3%;抗痨二线药物耐药情况分别为卷曲霉素31.2%/26.4%、氧氟沙星21.8%/25.2%、卡那霉素18.7%/15.9%、丙硫异烟胺6.2%/8.1%.HIV+Ⅰ组、HIV+Ⅱ组及HIV+Ⅲ组患者MTB培养阳性率分别为31.6%、58.7%与35.5%,耐药率分别为50.0%、40.7%、及27.3%,差异均无统计学意义(P>0.05).结论 AIDS合并腹腔结核性脓肿的MTB培养阳性率高于HIV阴性腹腔结核性脓肿,但是两组之间MTB耐药率无明显差异;在AIDS合并腹腔结核性脓肿患者中,未发现CD4+T淋巴细胞计数与MTB培养阳性率及MTB耐药率存在统计学相关性.因此,AIDS合并腹腔结核性脓肿进行MTB培养及耐药检测有利于制定合理的个体化的抗痨方案,获得理想预后.