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目的监测并分析北京市人类免疫缺陷病毒感染者或获得性免疫缺陷综合征患者(HIV/AIDS)合并分枝杆菌感染情况、菌种谱特征及耐药性,为临床确定诊断、流行病学分析及治疗评估提供理论依据。方法收集HIV/AIDS疑似合并分枝杆菌感染患者标本410人份(其中血液培养标本98人份,局部标本312人份),进行分枝杆菌的菌种分离。将分离出的分枝杆菌与首都医科大学附属地坛医院选择HIV/AIDS疑似合并分枝杆菌感染患者标本以同样方法分离出的60株分枝杆菌传代培养,选择有效菌株进行菌种鉴定及耐药性分析。结果 98人份血液标本、312人份局部标本中抗酸染色阳性分枝杆菌的阳性率分别为11.22%(11/98)、8.97%(28/312)。其中有4株为痰液和血液重复培养阳性,将其按照重复样本计算后,共分离出35株非重复性分枝杆菌。加上首都医科大学附属地坛医院HIV/AIDS疑似合并分枝杆菌感染患者中分离出的60株分枝杆菌共95株经传代培养,得到73株有效分枝杆菌菌株经鉴定与基因分型显示结核分枝杆菌(MTB)MTB株,占90.41%,结核分枝杆菌(NTM)7株占9.59%。其中7株非结核分枝杆菌经hsp65引物扩增测序后,筛选出4株鸟分枝杆菌、2株堪萨斯分枝杆菌、1株胞内分枝杆菌。66株MTB对8种抗结核药物的耐药率为:一线药物异烟肼(INH)33.33%、利福平(RFP)19.70%、链霉素(SM)45.45%、乙胺丁醇(EMB)12.12%,总耐药率为63.64%;二线药物卷曲霉素(CPM)50.00%、氧氟沙星(OFLX)22.73%、卡那霉素(K)24.24%、丙硫异烟胺(PTH)9.09%,总耐药率为59.09%。结论本市就诊的HIV/AIDS患者合并分枝杆菌的感染主要以MTB感染为主,同时有9.59%的NTM感染,应引起重视;HIV/AIDS合并分枝杆菌感染患者分枝杆菌对一线药物和二线药物的耐药非常严重。
Objective To monitor and analyze the prevalence of Mycobacterium infection, the characteristics of bacteria and the drug resistance in HIV-infected patients or Acquired Immunodeficiency Syndrome (HIV / AIDS) in Beijing and provide a basis for clinical diagnosis and epidemiological analysis And treatment evaluation to provide a theoretical basis. Methods A total of 410 HIV / AIDS patients with suspected mycobacterium tuberculosis infection (including 98 blood samples and 312 local samples) were collected for Mycobacterium species isolation. The mycobacterium isolated and the Capital Medical University Affiliated Ditan Hospital selected HIV / AIDS suspected merger mycobacterium infection in patients with the same method of isolation of 60 Mycobacterium subcultures, select effective strains for strain identification and drug resistance Sexual analysis. Results The positive rates of acid-fast stain mycobacteria in 98 blood samples and 312 samples were 11.22% (11/98) and 8.97% (28/312), respectively. Four of them were sputum and blood were repeatedly culture positive, according to repeated samples, 35 non-repetitive mycobacteria were isolated. In addition, 95 strains of 60 mycobacteria isolated from patients suspected of having combined mycobacterium tuberculosis infection in Ditan Hospital affiliated to Capital Medical University were subcultured, and 73 strains of effective mycobacteria were identified and genotyped to show tuberculosis Mycobacterium (MTB) MTB strains accounted for 90.41%, and Mycobacterium tuberculosis (NTM) 7 strains accounted for 9.59%. Among them, 7 strains of Mycobacterium tuberculosis were screened by hsp65 primer, and 4 strains of Mycobacterium avium, 2 strains of Mycobacterium kansasii and 1 strain of Mycobacterium intracellulare were screened. The resistance rates of 66 strains of MTB to 8 kinds of anti-tuberculosis drugs were as follows: first-line drug INH 33.33%, rifampin (RFP) 19.70%, streptomycin (SM) 45.45%, ethambutol ), The overall drug resistance rate was 63.64%; the second-line drugs 50.00% of caprine, OFLX 22.73%, kanamycin 24.24%, prothionamide (PTH ) 9.09%, the total drug resistance rate was 59.09%. Conclusion Mycobacterium infection in HIV / AIDS patients treated in our city is mainly infected with MTB, and 9.59% of NTM infection should be paid attention to. HIV / AIDS patients with mycobacterium tuberculosis infection of first-line drugs and Second-line drug resistance is very serious.