Danylo Halytsky Lviv National Medical University, Ukraina.
Georgian Med News. 2021 Nov(320):70-76.
Among 256 patients examined, 145 were diagnosed with multidrug-resistant pulmonary TB: 67 children and 78 teenagers from the focies with the multidrug-resistant TB (the main group), and 111 patients (35 children and 76 teenagers) from the focies with a chemosensitive TB (the control group). Molecular genetic testing of sputum, including the GeneXpert MTB / RIF method and the Hain Lifesciences linear probe analysis, was used to diagnose MRTB. It was found that the pulmonary TB was by 4.7 times more often revealed among the children under 1 year old (23.8%) and among a half of the children under 4 years old (59.6%) being from the focies with the multidrug-resistant TB (the maint group) as compared to those being from the localities with the drug-susceptible TB (the control group). At the same time, 17-year old teenagers prevailed in the main group. The teenagers from the main group were by 1.6 times more often diagnosed with MDR-TB/RifTB than the children, while the risk of MDR-TB was by 3.7 times more often detected among the children. Pre-extensive drug resistance was detected in 5.0% cases (1 child) and extensive drug resistance was also revealed in 5.0% cases (1 child), both pre-extensive drug resistance and extensive drug resistance were by 2 times more often revealed among the teenagers. The microbiological study of sputum for the susceptibility/resistance of the mycobacterium tuberculous strains showed that the resistance to HRS and HR combinations was more often revealed among the children (by 3.5 and 2.7 times correspondingly) than among the teenagers, while the resistance to HRESZ and HRES was revealed less often (by 2.7 and 1.6 times correspondingly). The children from the focies with the multidrug-resistant TB infection were diagnosed with the miliary TB (by 3.4 times), fibrous-cavernous pulmonary TB(by 2 times) and disseminated TB (by 1.4 times) more often than in the control group. Meningocephalitis (4.9% - 4) and caseous pneumonia (2.9% - 2) were detected only in the main group of children. The teenagers were statistically more often diagnosed with the fibrous-cavernous TB (by 3.5 times), miliary TB (by 2.5 times) and caseous pneumonia (by 2.3 times), while the infiltrative TB was by 1.7 times less often revealed as compared to the control group. Most of the infected children (65.6%) and teenagers (61.5%) from the main group were diagnosed after visiting their family physicians. The moderate state was evident in 35.8% cases (24 children) and the severe state was revealed in 46.3% cases (31 children) in the main group. The frequent TB forms were detected among the children (44.7%) and teenagers (59.0%), however, the moderate and severe states were revealed among the children by 1.3 times more often than among the teenagers.
在接受检查的 256 名患者中，有 145 人被诊断患有耐多药肺结核：67 名儿童和 78 名青少年来自耐多药结核病高发地区（主要组），111 名患者（35 名儿童和 76 名青少年）来自药物敏感结核病高发地区（对照组）。采用 GeneXpert MTB / RIF 方法和 Hain Lifesciences 线性探针分析对痰进行分子遗传学检测，以诊断 MRTB。结果发现，1 岁以下儿童（23.8%）和 4 岁以下儿童（59.6%）患耐多药肺结核的比例是耐多药结核病高发地区（主要组）的 4.7 倍，而药物敏感结核病高发地区（对照组）。同时，17 岁的青少年在主要组中占主导地位。主要组中的青少年比儿童更容易被诊断为 MDR-TB/RifTB，而儿童患 MDR-TB 的风险高出 3.7 倍。在 5.0%的病例（1 例）中检测到预广泛耐药，在 5.0%的病例（1 例）中也发现了广泛耐药，青少年中预广泛耐药和广泛耐药的比例分别高出 2 倍。对结核分枝杆菌菌株的药敏/耐药性进行的痰微生物学研究表明，儿童对 HRS 和 HR 联合用药的耐药性（分别高出 3.5 倍和 2.7 倍）比青少年更常见，而对 HRESZ 和 HRES 的耐药性（分别高出 2.7 倍和 1.6 倍）则不太常见。耐多药结核病高发地区的儿童比对照组更容易被诊断为粟粒性肺结核（高出 3.4 倍）、纤维空洞性肺结核（高出 2 倍）和播散性肺结核（高出 1.4 倍）。脑膜炎（4.9%，4 例）和干酪性肺炎（2.9%，2 例）仅在主要组的儿童中发现。青少年患纤维空洞性肺结核（高出 3.5 倍）、粟粒性肺结核（高出 2.5 倍）和干酪性肺炎（高出 2.3 倍）的比例更高，而浸润性肺结核的比例比对照组低 1.7 倍。主要组中大多数受感染的儿童（65.6%）和青少年（61.5%）是在就诊家庭医生后被诊断出来的。35.8%的病例（24 例）表现为中度，46.3%的病例（31 例）表现为重度，主要组中表现为重度。儿童（44.7%）和青少年（59.0%）中发现了较为频繁的肺结核形式，但儿童中度和重度的比例比青少年高出 1.3 倍。
