【作者】 王晓秋；

【导师】 叶松； 李朝品；

【作者基本信息】 安徽理工大学 ， 病原生物学， 2005， 硕士

【摘要】 目的 研究淮南矿区尘肺结核患者结核分枝杆菌L型的感染、耐药情况及其临床意义。 方法 对研究组与对照组患者均进行痰结核分枝杆菌细菌型和L型培养,用改良IK染色法对培养物作涂片镜检,将阳性培养物转种至鉴定培养基培养鉴定,同时对L型阳性培养物进行PCR鉴定,并对所分离到的L型菌株进行回复试验及药物敏感性检测。 结果 研究组60例尘肺结核患者中,结核分枝杆菌细菌型培养阳性14例(23.4%),L型培养阳性29例(48.3%),二者之间差异极其显著(x~2=7.95,P<0.005);Ⅰ、Ⅱ、Ⅲ期尘肺L型阳性检出率分别为30.0%、62.5%、83.3%,各期之间差异显著(x~2=8.88,P<0.05)。经PCR鉴定,29例L型培养阳性物中,23例呈阳性反应,6例呈阴性反应。对照组60例单纯尘肺患者中,细菌型培养均为阴性,L型培养阳性3例(5.0%),PCR鉴定均呈阳性反应。32株L型菌株均为耐药株,对INH、RFP、EMB、SM的耐药率分别为75.0%、90.6%、78.1%、50.0%,其中多耐药株27株(84.4%),包括同时耐四种药的11株(34.4%),耐三种药的13株(40.6%),耐两种药的3株(9.4%):单耐药株5株(15.6%);此外,24株(75.0%)可回复为结核分枝杆菌细菌型。 结论 淮南矿区尘肺结核患者结核分枝杆菌L型的感染率较高,且耐药情况较为严重,大多数结核分枝杆菌L型具有回复为细菌型而导致结核病的内源性复发的潜在倾向。开展结核分枝杆菌L型检测及药物敏感性试验对减少尘肺结核复发的漏诊或误诊,提高尘肺结核的早期诊断率以及指导临床用药方面有着重要的意义。更多还原

【Abstract】 Objective To study infection caused by Mycobacterium tuberculosis L-forms and its’ drug resistance in cases of pneumoconiosis complicated with pulmonary tuberculosis and evaluate its clinical significance.Methods Sputum culture for Mycobacterium tuberculosis and its L-forms was conducted in both research and contrast groups, and IK acid fast smear was used for primary identification, the positive culture sedimentation was subsequently inoculated into identification culture medium to make further identification, PCR assay was also used to detect positive culture sedimentation of L-forms. Finally, reversion trial and drug resistance experiment were carried out to L-forms. Results In research group, of total 60 cases, culture positive rate of Mycobacterium tuberculosis was 23.4% (14 cases), and that of L-forms was 48.3% (29 cases), the difference was quite notable ( x2=7.95, P<0.005). Furthermore, the detected positive rate of L-forms ascended following the increase of pneumoconiosis stage (stage I was 30.0%, stage II was 62.5%, stage HI was 83.3%), the striking difference among various stages was seen( x2-8.88, P<0.05). Of 29 cases of positive culture sedimentation of L-forms, 23 cases were identified positive and 6 cases negative by PCR assay. While in contrast group, none of all 60 cases was found sputum Mycobacterium tuberculosis culture positive, but culture positive rate of its L-forms reach 5.0% (3 cases), which were all identified positive by PCR assay. No typical symptom of tuberculosis was found in patients infected by L-forms. All 32 L-forms were identified to be drug resisitant strains, the drug resistance rates to INH, RFP, EMB, SM were 75.0%, 90.6%, 78.1%, 50.0% respectively, multi-drug resistant strains were 27(84.4%), including 11 strains(34.4%) resisting to 4 kinds of drugs, 13(40.6%) to 3 kinds of drugs, 3(9.4%) to 2 kinds of drugs and 5(15.6%) to single drug.Conclusions The infectious rate of Mycobacterium tuberculosis L-forms in cases of pneumoconiosis complicated with tuberculosis is much high, and the status of drug resistance is pretty bad , most of L-forms own latent ability of reversion to bacterium form which can cause endogenic recurrence of tuberculosis. It is of important significance to carry out detecting Mycobacterium tuberculosis L-forms and its drug resistance, which can diminish mistakes in diagnosis on recurrence of tuberculosis, and facilitate early diagnosis of tuberculosis as well as usage of drugs.更多还原