肺外结核病分布及耐药分析  

Distribution and drug-resistant of extrapulmonary tuberculosis

作　　者：袁阳[1,2] 李瑜琴[1] 陈玲[1] 张建勇[1] 向敏[1] 何月娟[1] 李娜娜[1] YUAN Yang;LI Yu-qin;CHEN Ling;ZHANG Jian-yong;XIANG Min;HE Yue-juan;LI Na-na(Second Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical College （ Research Institute of Tuberculosis）, Zunyi, Guizhou 563003, Chin)

机构地区：[1]遵义医学院附属医院呼吸二科遵义医学院结核病研究所,贵州遵义563003 [2]四川省遂宁市第一人民医院,四川遂宁629000

出　　处：《中国临床研究》2018年第4期535-537,共3页Chinese Journal of Clinical Research

基　　金：国家自然科学基金(81360002)

摘　　要：目的了解近年就诊于一所省级三甲综合医院肺外结核病的分布和耐药情况,为肺外结核病的诊治提供参考依据。方法收集2013年1月至2017年7月就诊于遵义医学院附属医院的肺外结核病患者组织标本,经罗氏培养基培养,比例法进行四种一线抗结核药物的药敏试验;进行人口学和临床资料以及耐药情况分析。结果获得84例肺外结核病培养及药敏信息,其中单纯肺外结核病30例,肺外结核合并肺结核54例。单纯肺外结核以泌尿系统结核最为常见,其次为颈部淋巴结结核和结核性胸膜炎;肺外结核合并肺结核以结核性胸膜炎和脑膜炎多见。30例单纯肺外结核病中,初治29例,耐药率13.8%(4/29);复治1例,其耐异烟肼和链霉素,耐药率100%(1/1);初治复治中均无多药耐药病例。54例肺外结核合并肺结核中,初治51例,耐药率13.7%(7/51),耐多药5.9%(3/51);复治3例,其中无耐药病例。结论单纯肺外结核病中以泌尿系统结核最为常见,耐多药发生率低;肺外结核合并肺结核中以结核性胸膜炎和脑膜炎多见,耐多药率较高。应加强肺外结核病组织标本的收集与耐药检测,以达早期诊断与合理治疗的目的。Objective To observe the distribution and drug-resistant status of extrapulmonary tuberculosis（Tb） in a Provincial Grade-Three Class-A Comprehensive Hospital in recent years to provide reference for the diagnosis and treatment of extrapulmonary Tb. Methods Clinical specimens were collected from patients with extrapulmonary Tb treated in the Affiliated Hospital of Zunyi Medical College from January 2013 to July 2017,and the drug sensitivity tests of 4 first-line anti-tuberculosis drugs were conducted by proportion method（Roche medium）. The status of demography,clinical data and drug-resistant were analyzed. Results The clinical and bacterium information of 84 patients with extrapulmonary Tb were obtained successfully,in which 30 cases were defined as simple extrapulmonary Tb and 54 as extrapulmonary Tb complicated with pulmonary Tb. Urinary Tb was the most common form of simple extrapulmonary Tb,followed by cervical lymph node Tb and Tb pleurisy,while Tb pleurisy and Tb meningitis were more common in extrapulmonary Tb complicated with pulmonary Tb. Among 30 cases of simple extrapulmonary Tb,29 were initial treatment of patients,and the drug resistant rate was 13. 8%（4/29）; only one patient was re-treated owing to isoniazid-and streptomycin-resistance,and the drug resistant rate was 100%（1/1）. There were no multi-drug resistant Tb cases in simple extrapulmonary Tb. Among 54 cases of extrapulmonary Tb with pulmonary Tb,51 were initial treatment of patients,the drug resistant rate was 13. 7%（7/51）,and multi-drug resistant rate was 5. 9%（3/51）; there were no drug-resistant cases in 3 previously treated patients.Conclusions Urinary tuberculosis is the most common form in simple extrapulmonary tuberculosis,and the incidence rate of multi-drug resistant tuberculosis is low. Tuberculous pleurisy and meningitis are common in extrapulmonary tuberculosis with pulmonary tuberculosis,and the incidence rate of multi-drug resistance tuberculosis is high. Collection of the clinical specimens and drug susce

关 键 词：肺外结核病 肺结核 结核分枝杆菌 分布 耐药 

分 类 号：R52[医药卫生—内科学]