肺结核患者确诊前抗菌药物暴露情况及其对T细胞斑点试验的影响  

Antibiotic exposure before the diagnosis of pulmonary tuberculosis in patients and the effect on T-cell spot test

作　　者：曾路 仵倩红 李洁 蒋红利[1] Zeng Lu;Wu Qianhong;Li Jie;Jiang Hongli(Department of Blood Purification,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Tuberculosis Internal Medicine,Shaanxi Provincial Tuberculosis Prevention and Control Hospital,Xi'an 710100,China)

机构地区：[1]西安交通大学第一附属医院血液净化科,西安710061 [2]陕西省结核病防治院结核内科,西安710100

出　　处：《国际流行病学传染病学杂志》2022年第3期168-171,共4页International Journal of Epidemiology and Infectious Disease

基　　金：国家自然科学基金(81870507)。

摘　　要：目的探讨肺结核患者明确诊断前抗菌药物暴露情况及其对结核感染T细胞斑点试验(T-SPOT)结果的影响。方法收集西安交通大学第一附属医院2014年8月1日至2019年8月1日首次确诊肺结核的455例患者资料,包括患者的年龄、性别、既往史、入院前药物治疗情况和主要实验室化验结果等,分析抗菌药物的应用情况及其与实验室指标、T-SPOT检测结果的相关性。结果455例患者中,261例(57.36%)有抗菌药物应用史,其中38.31%(100例)暴露于1种抗菌药物,17.24%(45例)暴露于2种抗菌药物,4.21%(11例)暴露于3种及以上抗菌药物。157例患者有详细记录应用抗菌药物的类别,β-内酰胺类(60.51%,95例)和喹诺酮类(43.95%,69例)应用频率较高。抗菌药物的应用与就诊时呼吸系统症状有相关性(F=34.19,P<0.001),但不影响T-SPOT的结果。T-SPOT斑点形成细胞(SFCs)水平高低与淋巴细胞计数(LYM)及单核细胞计数(MONO)高低有相关性(LYM:F=6.31,P=0.043;MONO:F=8.47,P=0.014)。结论结核病患者在明确诊断前常暴露于1~2类抗菌药物,β-内酰胺类药物及喹诺酮类药物应用频率较高。诊断明确前抗菌药物的应用对T-SPOT结果的判定无明显影响。Objective To investigate the exposure of antibiotics before the diagnosis of pulmonary tuberculosis in patients,and the effect on T-cell spot test(T-SPOT)of tuberculosis infection.Methods A total of 455 patients who were diagnosed with pulmonary tuberculosis for the first time in The First Affiliated Hospital of Xi'an Jiaotong University from August 1,2014 to August 1,2019 were enrolled.the clinical data of age,gender,medical history,treatment before diagnosis confirmation,and laboratory parameters of these patients were collected.The relationship between antibiotic application and laboratory parameters as well as T-SPOT results were analyzed.Results A total of 261(57.36%)in 455 patients had a history of antibiotic using,among whom 38.31%(100 cases)were exposed to one antibiotic,17.24%(45 cases)were exposed to two antibiotics,4.21%(11 cases)were exposed to three or more antibiotics.The detailed information of antibiotic categories in 157 patients showed thatβ-lactam(60.51%,95 cases)and quinolones(43.95%,69 cases)had high frequency of utilization.The respiratory symptoms at admission could affect the use of antibiotics(F=34.19,P<0.001).However,it had no effect on the result of T-SPOT.The level of T-SPOT spot forming cells(SFCs)had relationship with the results of lymphocyte(LYM)and monocytes(MONO)(LYM:F=6.31,P=0.043;MONO:F=8.47,P=0.014).Conclusions Patients are commonly exposed to one or two antibiotics before the diagnosis of pulmonary tuberculosis.β-lactam drugs and quinolones have the high frequency of application.The use of antibiotics before the diagnosis of pulmonary tuberculosis in patients has no effect on the result of T-SPOT.

关 键 词：结核 抗菌药物 T细胞斑点试验 相关性研究 药物暴露 

分 类 号：R521[医药卫生—内科学]