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目的分析深圳市罗湖辖区结核病患者结核分枝杆菌(Mycobacterium tuberculosis,MTB)及其L型(MTB-L)的感染状况,探讨MTB-L感染对结核病患者痰菌阴转率的影响。方法采用抗酸染色法检测辖区内2010-2011年收治的960例结核病确诊患者(初治916例、复治44例)的痰液标本并分析其治疗期间MTB和MTB-L的阳性检出率。计算结核病痰菌涂阳患者2、3月末痰菌阴转率,比较MTB阳性、MTB+MTB-L阳性以及MTB-L阳性患者痰菌阴转率的差异。结果916例初治患者中MTB阳性患者411例、MTB+MTB-L阳性患者130例、MTB-L阳性患者129例,初治结核病患者中MTB阳性患者2、3月末痰菌阴转率(90.3%、99.5%)均分别高于MTB+MTB-L阳性患者(46.9%、89.2%)及MTB-L阳性患者(45.7%、89.1%),差异均有统计学意义(P<0.05);而MTB+MTB-L阳性患者2、3月末痰菌阴转率与MTB-L阳性患者比较差异均无统计学意义(P>0.05)。44例复治结核病患者中MTB阳性患者12例、MTB+MTB-L阳性患者19例、MTB-L阳性患者13例,MTB阳性患者2月末痰菌阴转率(83.3%)分别高于MTB+MTB-L阳性患者(42.1%)及MTB-L阳性患者(38.5%),差异均有统计学意义(P<0.05);MTB阳性患者3月末痰菌阴转率(91.7%)分别略高于MTB+MTB-L阳性患者(73.7%)及MTB-L阳性患者(76.9%),但差异均无统计学意义(P>0.05);MTB+MTB-L阳性患者2、3月末痰菌阴转率与MTB-L阳性患者比较差异均无统计学意义(P>0.05)。结论 MTB-L感染可能是结核病患者痰菌阴转率低的重要原因,加强MTB-L感染监测是当前结核病防控的重要策略之一。
Objective To analyze the infection status of Mycobacterium tuberculosis (MTB) and its type L (MTB-L) in patients with tuberculosis in Luohu district, Shenzhen, and to explore the effect of MTB-L infection on sputum negative conversion rate in patients with tuberculosis. Methods Acid-fast staining was used to detect the sputum specimens from 960 confirmed tuberculosis patients (916 newly diagnosed and 44 retreated) admitted to our district from 2010 to 2011 and analyzed the positive detection rate of MTB and MTB-L . The sputum negative rate at the end of February and March was calculated, and the difference of sputum negative conversion rate between MTB + MTB-L positive and MTB-L positive patients was compared. Results Among the 916 newly diagnosed patients, there were 411 MTB positive patients, 130 MTB + MTB-L positive patients and 129 MTB-L positive patients. The MTB positive sputum negative conversion rate (90.3 %, 99.5%) were significantly higher than that of MTB + MTB-L positive patients (46.9%, 89.2%) and MTB-L positive patients (45.7%, 89.1%, respectively) The MTB + MTB-L positive patients had no significant difference in sputum negative conversion rate between the two groups at the end of 3 and 3 months (P> 0.05). Twenty-four MTB positive patients, 19 MTB + MTB-L positive patients and 13 MTB-L positive patients were found in 44 retreatment tuberculosis patients. The sputum negative conversion rate (83.3%) in MTB positive patients was higher than MTB + MTB-L positive patients (42.1%) and MTB-L positive patients (38.5%), the difference was statistically significant (P <0.05); MTB positive patients at the end of 3 sputum bacterial negative conversion rate (91.7% MTB + MTB-L positive patients (73.7%) and MTB-L positive patients (76.9%), but the difference was not statistically significant (P> 0.05); MTB + MTB-L positive patients at the end of 2, There was no significant difference between the two groups in MTB-L positive rate (P> 0.05). Conclusion MTB-L infection may be an important reason for low sputum negative conversion rate in TB patients. To strengthen MTB-L infection monitoring is one of the important strategies for prevention and control of TB.