肺结核并发各种类型肺外结核患者的分布及其耐药情况分析  

Analysis of Distribution and Drug Resistance of Pulmonary TB Patients with Concurrent Extrapulmonary TB

作　　者：陈素婷[1] 付育红[1] 赵立平[1] 薛毅 黄海荣[1] Chen Suting;Fu Yuhong;Zhao Liping;Xue Yi;Huang Hairong(National Laboratory on Clinical Tuberculosis,Beijing Key Laboratory for Drug Resistant Tuberculosis Research,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Institute,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所耐药结核病研究北京市重点实验室国家结核病临床实验室,101149

出　　处：《结核病与胸部肿瘤》2018年第4期253-257,共5页Tuberculosis and Thoracic Tumor

基　　金：国家自然科学基金(31600107);北京市优秀人才项目(2015000021469G189);北京市医院管理局重点医学专业发展计划(ZYLX201824);北京市医院管理局“登峰”人才培养计划(DFL20181602).

摘　　要：目的探讨肺结核并发各种类型肺外结核患者的分布及其耐药情况。方法选取2013年1月至2015年12月在首都医科大学附属北京胸科医院住院治疗的347例肺结核并发肺外结核患者(男199例,女148例)为研究对象,回顾性分析患者的年龄、性别、肺外结核并发感染部位等临床特征.同时对痰菌培养阳性的结核分枝杆菌临床分离株进行药物敏感性试验。比较分析并发不同类型肺外结核患者的耐药情况。结果347例肺结核并发肺外结核患者中,中位年龄33(24-52)岁,其中高发年龄为20-39岁,占41.8%(145/347).常见并发肺外结核的类型依次为:骨关节结核112例(32.3%,112/347),淋巴结结核96例(27.7%,96/347),结核性脑膜炎82例(23.6%,82/347),结核性腹膜炎23例(6.6%,23/347),结核性心包炎9例(2.6%,9/347),肠结核8例(2.3%,8/347),泌尿系结核和结核性多浆膜炎各5例(各占1.4%,5/347),肾结核2例(0.6%,2/347),脾结核、女性盆腔结核、肝结核、附睾结核和鼻结核各1例(各占0.3%,1/347).并发骨关节结核、淋巴结结核、结核性脑膜炎、结核性腹膜炎和其他类型肺外结核患者的中位年龄分别为:47(26.60)岁.26(20.42)岁.34(25.50)岁、26(20.46)岁和47(31.66)岁;上述各组中位年龄之间比较,差异有统计学意义(Х^2=36.25,P=0.000).347例患者中有189例患者进行了痰培养,对其中70例细菌培养阳性的临床分离株进行的药敏试验结果显示,肺结核并发肺外结核的总体耐药率为44.3%(31/70),单耐药率、多耐药率和耐多药率分别为11.4%(8/70)、2.9%(2/70)和30.0%(21/70)。结论肺结核并发肺外结核的累及部位广泛,其中最为常见的累及部位为骨关节、淋巴结和脑膜.肺结核并发肺外结核的总体耐药率高.Objective To explore the distribution and drug resistance of pulmonary TB patients combined with extra-pulmonary TB.Methods A total of 347 PTB patients(male:199,female:148)with concurrent EPTB were recruited from Beijing Chest Hospital Capital Medical University between Jan 2013 and Dec 2015,of which the clinical data such as age,gender and co-infection sites were retrospectively reviewed,and drug resistance patterns were analyzed.Results The median age of the cases was 33(24-52)years,and most patients were of 20-39 years old(41.8%(145/347)).Of the patients with concurrent EPTB,the types of TB disease included bone joint tuberculosis(n=112,32.3%),lymph node tuberculosis(n=96,27.7%),tuberculous meningitis(?82,23.6%)and tuberculous peritonitis(n=23,6.6%),tuberculous pericarditis(n=9,2.6%),intestinal tuberculosis(n=8,2.3%),urinary tuberculosis(?5,1.4%),polyserositis tuberculousis(n=5,1.4%),renal tuberculosis(n=2,0.6%),splenic tuberculosis(n=1,0.3%),pelvic tuberculosis(n=1,0.3%),liver tuberculosis(n=1,0.3%),epididymal tuberculosis(n=1,0.3%)and nasal tuberculosis(n=1,0.3%),respectively.The median ages of each group were 47(26-60)years,26(20-42)years,34(25-50)years,26(20-46)years and 47(31-66)years,respectively;there was significant difference among these groups(Х^2=36.25,P=0.000).The drug resistance patterns were analyzed in a total of 70 patients who had positive bacterial cultures.And 31 isolates were defined drug resistant,including 8 single-drug resistant,2 poly-drug resistant and 21 multidrug resistant(MDR)isolates according to the drug susceptibility test outcomes.The overall resistant ratio was 44.3%(31/70),while the ratios of single drug resistance,poly-drug resistance and multi-drug resistance were 11.4%(8/70),2.9%(2/70)and 30.0%(21/70),respectively.Conclusion Concurrent EPTB in PTB patients involves a wide range of types,of which the most common types are bone joint,lymph node and nervous system.The overall drug resistance ratio of PTB patients with concurrent EPTB is high.

关 键 词：结核 肺 结核 骨关节 结核 淋巴结 结核 脑膜 结核 抗多种药物性 数据说明 统计 

分 类 号：R378.16[医药卫生—病原生物学]