肺结核患者痰标本中结核分枝杆菌L型的检测及其临床意义  

Detection and clinical significance of L forms of mycobacterium tuberculosis in sputum of patients with pulmonary tuberculosis

作　　者：唐神结[1] 肖和平[1] 梅棋[1] 张莹蓉[1] 吴小珍[1] 吴福蓉[1] 张忠顺[1] 李红[1] 杨妍[1] 范琳[1] 沈晓栋[1] 

机构地区：[1]上海市肺科医院结核科,200433

出　　处：《上海医学》2002年第9期535-538,共4页Shanghai Medical Journal

摘　　要：目的　探讨肺结核患者结核分枝杆菌L型的检测及其临床意义。方法　对 12 4例活动性肺结核和 2 2例非活动性肺结核患者 ,分别作痰抗酸染色涂片、改良罗氏培养、BACTEC 960培养和结核分枝杆菌L型培养。结果　痰结核分枝杆菌L型培养阳性率显著高于改良罗氏培养 ,差异有显著性 (χ2 =4.6873 ,P <0 .0 5 ) ,也高于抗酸染色涂片和BACTEC 960培养 ,但差异无显著性 (P >0 .0 5 )。活动性肺结核患者L型培养阳性率为60 .48% ,显著高于非活动性肺结核患者 (χ2 =19.85 65 ,P <0 .0 0 1)。病程越长 ,痰结核分枝杆菌L型阳性率越高 ,但仅病程 >1年者与 <1个月者之间差异有显著性 (P <0 .0 5 )。复治病例L型培养阳性率显著高于初治病例 (χ2 =4.0 5 78,P <0 .0 5 )。有空洞患者L型培养阳性率为 71.19% ,显著高于无空洞患者 (χ2 =5 .3 941,P <0 .0 5 )。耐药和耐多药患者L型培养阳性率均显著高于敏感患者 (P <0 .0 5 )。化疗开始时痰结核分枝杆菌L型阳性者 ,化疗 6个月末痰菌阴转率显著低于L型阴性者 (χ2 =3 .913 8,P <0 .0 5 )。结论　结核分枝杆菌L型培养可提高结核分枝杆菌的阳性检出率 ,对结核病的早期、快速诊断具有重要价值。结核分枝杆菌L型感染X线表现特点为干酪样病变和空洞多。结核分枝杆菌L型耐药率高 ,临?Objective To investigate the clinical significance of L form of mycobacterium tuberculosis in patients with pulmonary tuberculosis. Methods Acid fast sputum smear, L J culture, bacteria culture and L form culture were conducted in 124 cases of active tuberculosis, 22 inactive tuberculosis, and the results were compared. Results Among the 124 active tuberculosis patients, the positive culture rate of L form mycobacterium tuberculosis was 60.48%, higher than that of L J culture( χ 2=4.6873, P <0.05);and also higher than that of acid fast smear and sputum bactec culture, but the differences were not significant( P >0.05). The positive rate of L form culture in active tuberculosis group was higher than that of inactive tuberculosis group( χ 2=19.8565, P <0.001).The longer the course of the disease was, the higher the positive rate of L form culture, but there was only a significant difference found between those longer than one year and those less than one month ( P <0.05). The positive rate of L form culture in the retreated patients was higher than those newly arose( χ 2=4.0578, P <0.05). The positive rate of L form culture in these with cavity was 71.19%, significantly higher than those without ( χ 2=5.3941, P <0.05). The positive rates of L form culture in the drug resistant group and multi drug resistant group were higher than those of the drug sensitive group( P <0.05). After 6 months' antituberculosis treatments, the negative conversion rates of sputum smear were significantly lower in the positive L form culture patients than in the negative ones( χ 2=3.9138, P < 0.05). Conclusion Sputum culture for L form of mycobacterium tuberculosis can raise the detection rate of mycobacterium tuberculosis and help early rapid diagnosis. The infection caused by L form mycobacterium tuberculosis is characterised by frequent presence of caseous lesions and cavitation in the chest film, and high drug resistance rate with poor therapeutic response, is bei

关 键 词：肺结核 结核分枝杆菌 L型菌 痰检 微生物检测 

分 类 号：R521[医药卫生—内科学]