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目的调查HIV合并结核感染患者体内的病原菌分布情况,并对患者的耐药情况进行分析。方法收集2014年1月—2016年1月河南省传染病医院收治的HIV/MTB双重感染及单纯结核患者136例,根据患者的感染情况将患者分为3组,56例HIV/MTB双重感染患者为HIV/MTB组,40例结核患者为MTB组,40例AIDS患者为HIV组。对3组患者进行标本采集,在MGIT管内开展相应的前处理后接种,采用绝对浓度法对培养阳性的菌株实施耐药性检测。统计患者体内的病原菌分布情况,并对其耐药性进行评价比较,记录实验结果,进行统计学分析。结果 3组患者的一般临床资料均无结核病史。3组患者的性别、年龄等资料比较差异无统计学意义(P>0.05)。HIV/MTB组患者成功分离出菌株38例,其检出阳性率为67.86%,共分离出菌株83株,部分病原菌分布与MTB组和HIV组比较,差异存在统计学意义(P<0.05)。MTB组与HIV组患者成功分离出菌株22例、24例,其检出阳性率分别为56.41%、58.54%,共分离出菌株分别为39株、41株,2组患者均易感染革兰阴性菌,与HIV/MTB组不同,且革兰阳性菌对3组患者的感染能力较低。HIV/MTB组中有2例(3.57%)对RFP、INH、OFL、KAN均耐药,而MTB组和HIV组不存在。HIV/MTB组总初始耐药(包括耐INH、耐SM)与MTB组和HIV组比较,差异有统计学意义(P<0.05)。结论在HIV合并结核感染患者治疗时,应选择联合用药治疗,以针对革兰阴性致病菌为主,还应同时考虑真菌、病毒、耶氏肺孢子菌等病原体。
Objective To investigate the distribution of pathogenic bacteria in HIV-infected patients with tuberculosis infection and to analyze the patients’ resistance. Methods 136 cases of HIV / MTB dual infection and simple tuberculosis were collected from Henan Infectious Disease Hospital from January 2014 to January 2016. The patients were divided into three groups according to their infection status. Fifty-six patients with HIV / MTB double infection In HIV / MTB group, 40 tuberculosis patients were MTB group and 40 AIDS patients were HIV group. Specimens were collected from 3 groups of patients. After pretreatment in MGIT tubes, the samples were inoculated. The absolute concentration method was used to detect the drug resistance of the positive cultures. Statistical analysis of the distribution of pathogens in patients with the body, and the drug resistance were compared, the experimental results were recorded for statistical analysis. Results The clinical data of 3 groups of patients had no history of tuberculosis. There was no significant difference in sex, age and other data among the three groups (P> 0.05). 38 cases were successfully isolated from HIV / MTB group. The positive rate was 67.86%. A total of 83 isolates were isolated from the HIV / MTB group. The distribution of some pathogens was statistically different from MTB group and HIV group (P <0.05). In the MTB group and the HIV group, 22 strains were successfully isolated and 24 cases were positive. The positive rates were 56.41% and 58.54%, respectively. There were 39 isolates and 41 isolates, respectively. Both groups were susceptible to Gram-negative Unlike the HIV / MTB group, Gram-positive bacteria have a lower ability to infect the three groups of patients. In HIV / MTB group, 2 cases (3.57%) were resistant to RFP, INH, OFL and KAN, but not MTB and HIV groups. The total initial drug resistance (including INH resistance and SM resistance) in HIV / MTB group was significantly different from that in MTB group and HIV group (P <0.05). Conclusion In the treatment of patients with HIV-associated tuberculosis infection, the combination therapy should be selected to target Gram-negative pathogens, and pathogens such as fungi, viruses and Pneumocystis sp. Should also be considered.