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成都地区6 107例肺外结核患者结核分枝杆菌感染与耐药情况
王冬梅
李青峰
朱玛
徐园红
罗佳
李樱杰
钟晶
吴张君
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2017.08.010
Analysis of infection and drug-resistance in 6 107 cases of extrapulmonary tuberculosis in Chengdu area
Wang Dongmei
Li Qingfeng
Zhu Ma
Xu Yuanhong
Luo Jia
Li Yingjie
Zhong Jing
Wu Zhangjun
Authors Info & Affiliations
Wang Dongmei
Public Health Clinical Centers of Chengdu, Clinical Laboratory, Chengdu 610066, China
Li Qingfeng
Zhu Ma
Xu Yuanhong
Luo Jia
Li Yingjie
Zhong Jing
Wu Zhangjun
·
DOI： 10.3760/cma.j.issn.1001-0939.2017.08.010
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摘要

目的分析成都地区近年来肺外结核患者MTB的感染及耐药情况，为结核病的防控和诊疗提供依据。

方法回顾性收集分析四川省成都市公共卫生临床医疗中心和成都各个防控督导点2013年1月至2015年12月组织来源为淋巴结、胸膜、腹膜、脑、泌尿系统、骨等肺外结核病例6 107例，其中男4 033例，女2 074例，年龄1～91岁，平均37岁。对其流行病学资料、感染和耐药情况采用SPSS 18.0软件进行统计分析，计数资料统计描述采用百分率(%)，计量资料统计描述采用 ± s表示。

结果成都地区2013年1月至2015年12月行MTB培养的21 036例患者中，培养阳性(培阳)7 119例(33.8%)，其中肺外结核6 107例中阳性896例，肺外结核培阳病例占全部培阳病例的12.6%(896/7 119)。2013—2015年肺外结核培阳病例呈逐年上升趋势，年平均递增率超过50%，病例分布以21～40岁为主(46.8%，419/896)；男性多于女性，男女比例为2.1∶1，平均年龄34岁。在淋巴结、胸膜、腹膜、脑膜、泌尿系统、骨和其他类型肺外结核病例中，骨结核病例培养阳性率最高(62/243，25.5%)，其次为淋巴结(283/1 297，21.8%)、胸膜(289/1 840，15.7%)、泌尿系统(63/452，13.9%)、腹膜(41/303，13.5%)、脑膜(156/1 915，8.1%)和其他类型结核(2/457，3.5%)；896例肺外结核病患者分离的MTB菌株对8种抗结核药的药物敏感度试验结果显示其耐药性从高到低依次为异烟肼、利福平、链霉素、氧氟沙星、环丙沙星、阿米卡星、卷曲霉素及乙胺丁醇。其耐多药和广泛耐药MTB的平均分离率分别为9.7%(87/896)和2.0%(17/896)。

结论成都地区近年来肺外结核的标本送检率和阳性检出率均呈逐年上升趋势，耐药率高于国内外研究水平，本地区肺外结核的防控和诊疗工作应进一步受到重视。

结核;分枝杆菌，结核;耐药
ABSTRACT

ObjectiveTo analyze the infection and drug resistance of extrapulmonary tuberculosis, in order to provide useful references for prevention and treatment of tuberculosis (TB).

MethodsA total of 6 107 suspected cases of extrapulmonary tuberculosis, including lymph node, pleural, peritoneal, meningeal, urinary tract, and bone tuberculosis, were collected retrospectively from January 2013 to December 2015 in Public Health Clinical Center of Chengdu. There were 4 033 male and 2 074 female patients, and the average age was 37 years.The epidemiological data, infection and drug resistance were analyzed statistically.

ResultsThere were 21 036 cases of mycobacterial culture from January 2013 to December 2015, of which 7 119 were positive(33.8%). Extrapulmonary tuberculosis was found in 6 107 cases, of which 896 were positive, accounting for 12.6% of the positive cases(896/7 119). Culture-positive cases of extra-pulmonary tuberculosis showed a rising trend from 2013 to 2015 ( n=174, 310, 421, respectively), and the annual average increasing rate was over 50%.Cases were distributed at younger ages (21-40 years), with an average age of 34 years.There were more male patients, with a male to female ratio of 2.1∶1. The most common site of extrapulmonary tuberculosis was the bone(62/243, 25.5%), followed by lymph node(283/1 297, 21.8%), pleural(289/1 840, 15.7%), urinary tract(63/452, 13.9%), peritoneum(41/303, 13.5%), meningeal(156/1 915, 8.1%)and other types of tuberculosis(2/57, 3.5%). Drug sensitivity test of 896 extrapulmonary tuberculosis strains showed that the resistance rate (from high to low) was in the order of isoniazid, rifampicin, streptomycin, ofloxacin, ciprofloxacin, amikacin, capreomycin and ethambutol. Multidrug-resistant(MDR)and extremely-drug resistant (XDR) rate was 9.7 %(87/896)and 2.0%(17/896)respectively.

ConclusionsCases of extrapulmonary tuberculosis sent for bacterial culture and the positive rate showed a rising trend by years in Chengdu area.The drug resistance level was higher than that reported both in China and abroad.The prevention and treatment of extrapulmonary tuberculosis should be strengthened in this area.

Tuberculosis; Mycobacterium tuberculosis ;Drug resistance
Wang Dongmei, Email: mocdef.6ab21gnodgnirreh
National High Technology Research and Development Program (2014AA022304); Sichuan Province Health Department Project (120558)
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引用本文

王冬梅,李青峰,朱玛,等. 成都地区6 107例肺外结核患者结核分枝杆菌感染与耐药情况[J]. 中华结核和呼吸杂志,2017,40(8)：592-595.

DOI:10.3760/cma.j.issn.1001-0939.2017.08.010

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MTB可由肺部病变通过血液或淋巴系统播散到人体的各个脏器，在肺部以外组织或器官定植后引起的结核病称为肺外结核。由于肺外结核组织分布的多样性和特殊性，常累及多系统和多器官，且病变呈多样化。样本获取困难或获取的样本含菌量少是肺外结核诊断困难且容易漏诊的原因。近年来，文献报道发达国家肺外结核病例约占全部结核病病例的12.0%～28.5% [ 1 , 2 , 3 , 4 , 5 ]，韩国肺外结核的检出率为20% [ 6 ]，在我国天津地区肺外结核占全部结核病例的21.22% [ 7 ]，且有上升趋势。我国结核病的疫情在全球一直居高不下，而西南地区的结核病疫情又最为严峻。目前，关于肺外结核的文献报道大多数仅限于实验室诊断技术和情况调查，少有对各类型肺外结核进行大样本的实验室综合分析。因此，本文对近年来成都地区的肺外结核病例的分布和各组织器官肺外结核标本的送检、菌种分布及耐药情况等进行综合分析，以期为临床肺外结核的防控和诊疗提供依据。
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备注信息
A
王冬梅，Email： mocdef.6ab21gnodgnirreh
B
国家高技术研究发展计划 (2014AA022304)
四川省卫生厅项目 (120558)
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