骨关节结核病灶中耐多药结核分枝杆菌对疗效的影响  

Influence of multi-drug resistant mycobacterium strain on the management of bone and joint tuberculosis

作　　者：吴启秋[1] 潘毓萱 毕志强 邓立宏 那希宽 

机构地区：[1]北京结核病胸部肿瘤研究所骨科,北京101149 [2]国家结核病参比试验室

出　　处：《中华骨科杂志》2005年第7期431-433,共3页Chinese Journal of Orthopaedics

摘　　要：目的回顾性探索骨关节结核病灶中耐多药结核分枝杆菌对骨关节结核病疗效的影响及其对策。方法1993至1999年,确诊为复治骨关节结核病250例,男143例,女107例;年龄2～72岁,平均25.44岁;病变在脊椎、髋、膝和其他小关节。穿刺或外科手术获得病灶中脓液、干酪样物或肉芽组织等为标本,以BACTECTB460检测仪进行结核菌培养和药敏试验,NAP试剂进行初级鉴定,NTM分离培养物进一步鉴定分枝杆菌菌种。结果250例标本中,分离培养阳性培养物48例。结核分枝杆菌46例,阳性率为18.4%。其中同时耐异烟肼(INH)、利福平(RFP)、链霉素(SM)和乙胺丁醇(EMB)中三种药的结核分枝杆菌4例,同时耐异烟肼、利福平、链霉素和乙胺丁醇11例,共15例(6%)。在15例中有8例此次手术后切口破溃形成窦道,依据药敏试验结果改变化疗方案治疗,并经前后2或3次再手术,7例治愈,1例因窦道继发感染而死亡。另2例为非结核分枝杆菌(NTM),1例鉴定为鸟胞内分枝杆菌复合群,另1例鉴定未有结果,但均为耐多药(INH、RFP、SM、EMB、KM、CS)的NTM,治疗效果差。结论骨关节结核病灶中发现耐多药结核分枝杆菌(6%)和非结核分枝杆菌的病例,疗效极差,此类病例的化疗方案应个体化,可能需要多次手术才能治愈。Objective To investigate the influence of multi-drug resistant mycobacterium strain tuberculosis (MDR-TB) on the clinical outcomes and its countermeasures in the treatment of bone and joint tuberculosis. Methods From December 1993 to June 1999, 250 revised cases were admitted in our hospital, which were 143 males and 107 females aging from 2 to 72 years with an average of 25.44 years. The most of lesions were located at spine, then the hip, knee and small joints. The specimens were harvested via need biopsy or operation from the lesion. Specimens were examined by Bactec TB 460 to identify tuberculosis mycobacterium and non tuberculosis mycobacterium strain, and drugs-sensibility test to INH(0.2 μg/ml), SM (6.0 μg/ml), RFP (2.0 μg/ml) and EMB (7.5 μg/ml) respectively. Results Of 250 patients, Mycobacterium were positive in 48 by Bactec measurement, which were tuberculosis mycobacterium strain in 46 with 18.4% positive rate, and non tuberculosis mycobacterium strain in 2(1 mycobacterium avium intracellulare complex, the other unkown). Of the 46 positive specimens, 27 were sensitive to all of 4 drugs(58.7%), however, 3 were resistant to 1 drug(6.5%), 1 was resistant to 2 drugs(2.1%), 4 were resistant to 3 drugs (8.7%), and 11 were resistant to 4 drugs(24%). In 11 patients resistant to 4 drugs and 2 patients with non tuberculosis mycobacterium strain, 8 were complicated with sinuses after the first operation, in which 7 healed after 2 to 3 re-operations and 1 died of secondary infection. 1 M. avium intracellulare complex and 1 unidentified mycobacterium were multi-drug resistant strains( INH,RFP, SM, EMB) and found with poor clinical results.Conclusion Those cases with MDR-TB in lesions can influence the curative effect of bone and joint tuberculosis significantly. Based on the drug-sensibility, the chemotherapy regimen should be modified and individualized, and requires several operations to cure.

关 键 词：耐多药结核分枝杆菌 结核病灶 非结核分枝杆菌 骨关节结核病 BACTEC 耐异烟肼 乙胺丁醇 1999年 TB460 外科手术 肉芽组织 药敏试验 分离培养 术后切口 方案治疗 试验结果 继发感染 治疗效果 化疗方案 多次手术 培养物 NTM 

分 类 号：R529.2[医药卫生—内科学]