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中国北京艾滋病合并肺结核患者分离的结核分枝杆菌对四种一线抗结核药物的耐药特征。

Drug resistance characteristics of Mycobacterium tuberculosis isolates to four first-line antituberculous drugs from tuberculosis patients with AIDS in Beijing, China.

机构信息

Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.

National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China.

出版信息

Int J Antimicrob Agents. 2015 Feb;45(2):124-9. doi: 10.1016/j.ijantimicag.2014.09.013. Epub 2014 Oct 22.

Abstract

The objective of this study was to investigate the drug resistance characteristics of Mycobacterium tuberculosis isolates to four first-line antituberculous drugs (ATDs) from tuberculosis (TB) patients with AIDS in Beijing, China. All M. tuberculosis strains were isolated from specimens from TB patients with AIDS hospitalised between April 2010 and October 2012. Isolates were cultured by mycobacterial culture methods and were identified by multilocus PCR. Drug sensitivity testing was performed by the proportion method with the following first-line ATDs: isoniazid; rifampicin; streptomycin; and ethambutol. Results were compared with the drug resistance status of M. tuberculosis strains isolated from TB patients without HIV infection in Beijing. Among 41 M. tuberculosis isolates from TB patients with AIDS, the rates of total drug resistance (58.5%), initial drug resistance (46.7%) and acquired drug resistance (90.9%) were significantly higher than in TB patients without HIV infection (34.1%, 24.5% and 48.5%, respectively; P<0.05). In TB patients with AIDS, the rates of acquired drug resistance (90.9%) and acquired multidrug-resistant TB (MDR-TB) (54.5%) were significantly higher than the rates of initial drug resistance (46.7%) and initial MDR-TB (10.0%) (P<0.05). In patients with TB without HIV infection, the rate of acquired drug resistance (48.5%) was significantly higher than the rate of initial drug resistance (24.5%) (P<0.05). M. tuberculosis drug resistance in TB patients with AIDS is significantly more serious than in TB patients without HIV infection. These results showed that more attention should be paid to M. tuberculosis drug resistance in AIDS patients.

摘要

本研究旨在调查中国北京艾滋病合并结核病(TB)患者中分离的结核分枝杆菌(MTB)对 4 种一线抗结核药物(ATD)的耐药特征。所有 MTB 菌株均从 2010 年 4 月至 2012 年 10 月期间住院的 AIDS 合并 TB 患者的标本中分离。采用分枝杆菌培养方法进行菌株培养,并采用多位点 PCR 进行鉴定。采用比例法进行药物敏感性试验,试验药物包括异烟肼、利福平、链霉素和乙胺丁醇。结果与北京无 HIV 感染的 TB 患者分离的 MTB 菌株耐药状况进行比较。在 41 株 AIDS 合并 TB 患者的 MTB 分离株中,总耐药率(58.5%)、初始耐药率(46.7%)和获得性耐药率(90.9%)均显著高于无 HIV 感染的 TB 患者(分别为 34.1%、24.5%和 48.5%;P<0.05)。在 AIDS 合并 TB 患者中,获得性耐药率(90.9%)和获得性耐多药结核病(MDR-TB)率(54.5%)显著高于初始耐药率(46.7%)和初始 MDR-TB 率(10.0%)(P<0.05)。在无 HIV 感染的 TB 患者中,获得性耐药率(48.5%)显著高于初始耐药率(24.5%)(P<0.05)。AIDS 合并 TB 患者的 MTB 耐药性明显比无 HIV 感染的 TB 患者更严重。这些结果表明,应更加关注 AIDS 患者的 MTB 耐药性。

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