论文部分内容阅读
目的提高艾滋病(AIDS)合并结核病(TB)的病原学诊断的阳性率,获得AIDS合并TB临床分离结核分枝杆菌菌株对一线抗结核药物的耐药率。方法采用萋-尼抗酸染色、BacT/ALERT3D360MP结核分枝杆菌培养和实时荧光定量聚合酶链反应(PCR),对AIDS合并疑似结核分枝杆菌感染病人不同时段的样本同时进行检测;对结核分枝杆菌培养阳性物,经抗酸染色和TB-DNAPCR确认为结核分枝杆菌的进行抗结核药敏试验。结果涂片萋-尼抗酸染色阳性率为11.69%(18/154);样本直接进行TB-DNAPCR扩增的阳性率18.18%(28/154);MP培养阳性经抗酸染色和TB-DNAPCR确认结核分枝杆菌的阳性率20.13%(31/154)。临床分离株对抗结核一线药物的敏感试验结果显示,异烟肼的耐药率高达81.48%,其次是链霉素37.04%,乙胺丁醇和利福平分别为25.93%、18.52%。结论云南省AIDS合并结核分枝杆菌临床分离率为20.13%(31/154),AIDS合并非结核分枝杆菌的临床分离率为16.23%(25/154)。实时荧光PCR扩增TB-DNA能为临床提供早期病原学诊断依据,而结核分枝杆菌培养在提供病原学诊断“金标准”的同时,可为进一步检测其耐药性准备菌株。鉴于AIDS病人免疫缺陷的特殊性,需要采用多种方法对多份样本和多种类样本同时检测,提高检测的特异性和敏感性。
Objective To improve the positive rate of etiological diagnosis of AIDS complicated with tuberculosis (TB) and get the rate of resistance to first-line anti-tuberculosis drugs in clinical isolates of TB from AIDS patients with AIDS. Methods The samples of AIDS-infected patients with suspected Mycobacterium tuberculosis infection in different periods were tested simultaneously by the method of 萋-niacin staining, BacT / ALERT3D360MP Mycobacterium tuberculosis culture and real-time fluorescence quantitative polymerase chain reaction (PCR) Mycobacterium culture positive, by acid-fast staining and TB-DNAPCR identified as Mycobacterium tuberculosis anti-TB susceptibility testing. Results The positive rate of smegmatin-nicotinic acid staining was 11.69% (18/154). The positive rate of direct TB-DNAPCR amplification was 18.18% (28/154). The MP culture positive staining by acid-fast staining and TB-DNA PCR Confirmed the positive rate of M. tuberculosis 20.13% (31/154). The sensitivity of clinical isolates to the first-line drugs against tuberculosis showed that the drug resistance rate of isoniazid was as high as 81.48%, followed by streptomycin 37.04%, ethambutol and rifampin were 25.93% and 18.52% respectively. Conclusion The clinical isolates of AIDS with Mycobacterium tuberculosis in Yunnan Province were 20.13% (31/154). The clinical isolates of AIDS with non-tuberculous mycobacteria were 16.23% (25/154). The real-time fluorescent PCR amplification of TB-DNA can provide early etiological diagnosis for clinical diagnosis, and Mycobacterium tuberculosis culture provides the etiological diagnosis of “gold standard” at the same time, it can be prepared for further testing of drug resistance strains. In view of the particularity of immunodeficiency in AIDS patients, it is necessary to use multiple methods to detect multiple samples and multiple samples at the same time to improve the specificity and sensitivity of detection.