【摘要】 目的探讨结核性胸膜炎患者结核杆菌的耐药基因突变情况及其对疗效的影响。方法结核性胸膜炎患者行纤支镜代胸腔镜检查,胸膜活检标本行结核分枝杆菌耐药基因芯片检测,留置胸腔引流管,常规抗痨治疗。结果 46例患者,共检出野生型32例,结核耐药基因10例(21.7%),其中利福平rpoB基因突变5例,异烟肼katG基因突变6例,inhA基因突变2例,乙胺丁醇embB基因突变1例,链霉素rpsL基因突变1例,多耐药基因突变5例。耐药基因组住院时间12.1±3.1d,显著长于非耐药基因组的8.2±2.5 d,P<0.01;耐药基因组胸管留置时间7.0±2.6d,显著长于非耐药基因组的4.0±1.8 d,P<0.01;耐药基因组抗痨后热退时间6.8±1.6 d,显著长于非耐药基因组的4.2±1.4 d,P<0.01。结论结核性胸膜炎存在一定的耐药率,耐药基因的存在显著影响其疗效,结核杆菌耐药基因芯片快捷简便,对早期发现耐药结核性胸膜炎,作针对性抗痨治疗有一定临床意义。更多还原

【Abstract】 Objective To study the drug-resistance gene mutations in patients with mycobacterium tuberculous pleuritis and their influence on the therapeutic effect. Methods 46 patients with mycobacterium tuberculous pleuritis were given fiber bronchoscopy instead of thoracoscopy,and pleural biopsy specimens were detected by mycobacterium tuberculous gene chip. All cases were treated with chest tube drainage and anti-tuberculous therapy. Results There were 32 cases of wild-type gene and 10 cases of drug-resistance gene mutations,including 5 cases of mutations of rpoB gene against RFP,6 cases of mutations of katG gene against INH,2 cases of mutations of inhA gene against INH,1 case of mutations of embB gene against EMB,1 case of mutations of rpsL gene against SM,and6 cases of multidrug resistance gene. The duration of hospital stay was obviously longer in the group with drug-resistance gene mutations( 12. 1 ± 3. 1 d) than in the group without drug-resistance gene mutations( 8. 2 ± 2. 5 d)( P <0. 01). The chest tube drainage time was longer in the group with drug-resistance gene mutations( 7. 0 ± 2. 6 d) than in the group without drug-resistance gene mutations( 4. 0 ± 1. 8 d)( P < 0. 01). The defervescence time was longer in the group with drug-resistance gene mutations( 6. 8 ± 1. 6 d) than in the group without drug-resistance gene mutations( 4. 2 ± 1. 4 d)( P < 0. 01). Conclusion There are drug-resistance gene mutations in patients with mycobacterium tuberculous pleuritis and they influence the therapeutic effect significantly. Mycobacterium tuberculous gene chip technology is useful for the early detection of drug-resistance tuberculous pleuritis and may be useful for the anti-TB drug selection.更多还原