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目的分析矽肺患者结核分枝杆菌临床检验结果,并对分离菌株进行药敏检测。方法以2011年10月至2013年10月临床诊断为矽肺合并肺结核的127例患者(矽肺结核组)和53例无合并肺结核矽肺患者(矽肺组)为研究对象,收集患者的痰标本,分别进行结核分枝杆菌痰涂片检查和BACTEC-MGIT 960培养,并对培养阳性的结核分枝杆菌菌株作一线抗结核药物的药敏分析。结果矽肺结核组患者痰涂片检查和BACTEC-MGIT 960培养的阳性率均高于矽肺组(47.2%vs 0.0%,67.7%vs 5.7%,P<0.01);矽肺结核组患者BACTEC-MGIT 960培养的阳性率高于同组患者的痰涂片检查阳性率(67.7%vs 47.2%,P<0.01)。180例患者痰标本经BACTEC-MGIT 960培养检出结核分枝杆菌阳性者共89株,该89株分离株均对一线抗结核药物耐药,总耐药率为100.0%,耐多药率为28.0%。耐药顺序从高到低依次为异烟肼、链霉素、乙胺丁醇和利福平。结论矽肺患者标本中分离出的结核分枝杆菌对抗结核药物呈现较高的耐药率,对矽肺患者定期进行结核分枝杆菌感染的检查是防治耐药结核分枝杆菌菌株传播的有效措施。
Objective To analyze the clinical results of Mycobacterium tuberculosis in patients with silicosis and to test the susceptibility of the isolated strains. Methods From October 2011 to October 2013, 127 patients with silicosis and tuberculosis (silicotic TB) and 53 patients without silicosis (silicotic group) were enrolled in this study. The sputum specimens of patients were collected and performed separately Mycobacterium tuberculosis sputum smear examination and BACTEC-MGIT 960 culture, and culture-positive Mycobacterium tuberculosis strains for first-line anti-TB drug susceptibility analysis. Results The positive rates of sputum smear examination and BACTEC-MGIT 960 in patients with silicotic pulmonary tuberculosis were higher than those in silicotic group (47.2% vs 0.0%, 67.7% vs 5.7%, P <0.01) (67.7% vs 47.2%, P <0.01). The positive rate of sputum smear was higher in the same group than in the same group. A total of 89 sputum specimens of sputum from 180 patients were detected by BACTEC-MGIT 960 and 89 were positive for first-line anti-TB drugs. The total resistance rate was 100.0%, and the multi-drug resistance rate was 28.0%. The order of resistance was isoniazid, streptomycin, ethambutol and rifampicin from high to low. Conclusion Mycobacterium tuberculosis isolated from specimens of patients with silicosis showed a high resistance rate to anti-tuberculosis drugs. The regular examination of Mycobacterium tuberculosis infection in patients with silicosis is an effective measure to prevent the spread of drug-resistant strains of Mycobacterium tuberculosis.