广州地区HIV/AIDS患者合并感染非结核分枝杆菌的耐药分析  

Analysis on drug-resistance of Nontuberculous mycobacteria in patients with HIV/AIDS in Guangzhou

作　　者：邓西子 陈万山[1] 兰芸[1] 罗红彬[1] 蔡卫平[1] 李凌华[1] 唐小平[1] 胡凤玉[1] 

机构地区：[1]广州医科大学附属广州市第八人民医院传染病研究所,广东广州510060

出　　处：《热带医学杂志》2015年第2期170-173,共4页Journal of Tropical Medicine

基　　金：广州市卫生局重点项目(2009-Zdi-06);国家临床重点专科建设项目经费资助(2013-2014)

摘　　要：目的研究广州地区未经治疗的HIV/AIDS患者合并感染非结核分枝杆菌（NTM）原发表型耐药特征,为HIV/AIDS合并NTM病的临床治疗提供重要依据。方法经hsp65、16S-r DNA、16S-23S-r DNA ITS多基因测序的方法对2008~2013年期间分离自HIV/AIDS患者的147株分枝杆菌进行菌种鉴定,对鉴定为NTM的菌株,采用以罗氏培养基为基础的比例法,对于目前临床应用的一线和二线抗结核药物进行药物敏感性试验。结果 147株HIV/AIDS患者感染分枝杆菌中,鉴定为NTM的57株（38.8%）,其中鸟分枝杆菌15株（26.3%）,鸟分枝杆菌复合群10株（17.5%）,堪萨斯分枝杆菌7株（12.3%）。选取其中未混合感染的38株NTM进行药敏试验,结果显示：NTM对对氨基水杨酸异烟肼（力克肺疾,Pa）耐药率最高,为94.7%,其他依次为阿米卡星（86.8%）、链霉素（84.2%）、异烟肼（81.6%）、左氧氟沙星（68.4%）、克拉霉素（68.4%）、利福平（65.8%）、莫西沙星（39.5%）,而对丙硫异烟胺、乙胺丁醇、利福布汀较为敏感,敏感率依次为94.7%、84.2%、76.3%。结论广州地区HIV/AIDS患者合并感染NTM以鸟分枝杆菌和鸟分枝杆菌复合群为主。NTM对常用抗结核药原发耐药率较高,而丙硫异烟胺、乙胺丁醇、利福布汀对NTM有较好的抑菌效果。Objective To analyze the characteristic of primary drug-resistant phenotype of Nontuberculous mycobacteria （NTM）, which infected HIV/AIDS patients, who had not received drug treatment for NTM and HIV before in Guangzhou, and provide an important basis for the treatment of NTM diseasein patients with HIV/AIDS. Methods 147 NTM strains isolated from HIV/AIDS patients between 2008 and 2013 were identified by sequencing of multiple genes,including hsp65, 16SrDNA, and 16S-23SrDNA ITS.38 identified NTM isolates were subjected to drug susceptibility test using the proportion method on the basis of L-J Medium Base to determine their sensitivity to 11 first-line and second-line anti- tuberculosis drugs. Results Of 147 mycobacteria isolates, 57 （38.8%）were identified as Nontuberculous mycobacteria （NTM）, of which the main species were M.avium（15）, Mycobacterium avium complex （MAC）（10）, and M.kansasii （7）. Of 38 NTM strains without mycobacteria tuberculosis co-infection, the Pa-resistant rate reached 94.7%; other drug- resistant rates of AM, SM, INH, LOFLX, CLA, RFP and MOXI were 86.8%, 84.2%, 81.6%, 68.4%, 68.4%, 65.8% and 39.5%,respectively.While TH1321-, EMB- and RBD-sensitive rates were 94.7%, 84.2% and 76.3%, respectively. Conclusion The main NTM species infected HIV/AIDS patients in Guangzhou were M.avium and MAC. NTM showed natural resistance to the regular anti-tuberculosis drug. Protionamide,ethambutol and rifabutin have stronger bacteriostatic effect on NTM.

关 键 词：非结核分枝杆菌 艾滋病 耐药 

分 类 号：R512.91[医药卫生—内科学]