摘要
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 detection rate and test specificity of HIV/AIDS coinfected with TB,and to identify the prevalence of drug resistance of mycobacterium tuberculosis to first line anti-TB drugs in Yunnan province.Method Mycobacterium tuberculosis（MTB）was detected in AIDS patients coinfected with TB,using smearing,Bact/ALERT 3D 360 MP tuberculosis cultures and real time PCR.According to the masculine culture,drug resistance was tested for MTB strains confirmed by smearing and TB-DNA PCR.Results The positive rate of smearing was 11.69%（18/154）,and that for TB-DNA PCR and for culturing and TB-DNA PCR was 18.18%（28/154）and 20.13%（31/154）,respectively.The resistance rates against isoniazid（INH）,streptomycin（SM）,ethambutol（EMB）and rifampicin（RFP）were 81.48%,37.04%,25.93% and 18.52%,respectively.Conclusion The rate of clinical isolation of MTB in AIDS patients coinfected with TB was 20.13%（31/154）in Yunnan province,and the rate of clinical isolation in AIDS patients coinfected with non-tuberculosis mycobacterium（NTM）was 16.23%（25/154）.Real time TB-DNA PCR contributes to early etiological diagnosis in clinical practice,while MTB culturing provides the gold-standard for etiological diagnosis and also prepares relevant strains for further drug resistance test.Due to the immunodeficiency of HIV/AIDS patients,multiple test methods will be employed to test several and different types of specimens so as to improve their specificity and sensitivity.
出处
《中国艾滋病性病》
CAS
2010年第4期359-363,共5页
Chinese Journal of Aids & STD
基金
第四轮中国全球基金/中英艾滋病项目应用性研究项目(项目书编号:2008GF4OR36)~~
