目的 研究白细胞介素-6(IL-6)和可溶性生长刺激表达基因2蛋白(ST2)在普通型新型冠状病毒肺炎(简称新冠肺炎)患者中的表达及其临床意义.方法 选取该院2020年2月2—24日37例患者住院期间多个时间点的临床检测剩余血清或血浆样本,进行IL-6、ST2检测.结果 入院时的IL-6水平与其他感染炎症标志物[C反应蛋白(CRP)、乳糖脱氢酶(LDH)、降钙素原(PCT)、纤维蛋白原]显著相关.入院时IL-6升高者,住院期间的合并症(肝功能异常、细菌感染及心脏异常等)风险增加(RR=2.33,P=0.0029;OR=10.36,P=0.0411).部分患者入院时ST2升高(8％),住院期间ST2水平与IL-6显著相关,未显示与NT-proBNP水平相关,住院治疗期间ST2水平显著下降.结论 普通型的新冠肺炎患者血液IL-6和ST2动态变化,IL-6可提供危险分层信息,ST2或可以用于治疗效果的监测.

目的 了解重庆地区接受一线抗反转录病毒治疗(antiretroviral therapy,ART)后发生病毒学失败的HIV-1感染者耐药情况.方法 回顾性收集整理2015年5月—2020年6月在重庆市公共卫生医疗救治中心接受一线ART 1年后出现病毒学失败患者的临床资料,通过实时荧光定量(RT)-PCR测定HIV-1载量并扩增HIV-1基因,进行基因型耐药性分析,采用统计学卡方检验分析病毒学失败率、耐药发生率、耐药位点分布以及HIV-1基因型分布.采用Excel 2016进行数据收集、整理与图表制作,并分析病毒学失败率、耐药发生率、耐药位点分布和HIV-1基因型分布.结果 在3305例接受一线ART的患者中,348例(10.5％)出现病毒学失败,其中319例对至少一种抗病毒药物耐药.非核苷类反转录酶抑制剂(NNRTI)耐药率为99.1％(316/319),其中奈韦拉平(nevirapine,NVP)、地拉韦定(delavirdine,DLV)和依非韦仑(efavirenz,EFV)耐药率均超过95％;核苷类反转录酶抑制剂(NRTI)耐药发生率达91.5％(292/319),其中拉米夫定(lamivudine,3TC)和恩曲他滨(emtricitabine,FTC)耐药发生率均超过90％,齐多夫定(zidovudine,AZT)和蛋白酶抑制剂(protease inhibitor,PI)类耐药发生率低.M184V/I和K65R/N是NRTI类药物最常见的基因突变位点,K103N/R/S、G190A/S/E/Q、V179D/E和V106M/A是NNRTI类药物常见的基因突变位点;无论是否存在耐药,HIV-1亚型均与我国主要流行亚型相近.结论 该院一线ART治疗失败者耐药发生率高,耐药是HIV-1感者病毒学失败的主要原因;耐药最为严重的药物包括NVP、DLV、EFV、3TC和FTC,AZT和PI类药物耐药发生率低;耐药与HIV-1基因型无相关性.

目的 探讨新型冠状病毒(SARS-CoV-2)抗体在新型冠状病毒肺炎(COIVD-2019)患者和非COIVD-2019患者中的检测效果.方法 选取161例COIVD-2019患者和79例非COIVD-2019[合并人类免疫缺陷病毒(HIV)感染、结核和自身免疫性疾病]患者,采用免疫荧光层析法对患者的血清标本进行SARS-CoV-2 IgM和IgG抗体检测.结果 161例COIVD-2019患者SARS-CoV-2 IgM和IgG抗体阳率分别是88.82％(143/161)和93.79％(151/161).79例非COIVD-2019患者SARS-CoV-2 IgM和IgG抗体阳性率分别为16.46％(13/79)和7.59％(6/79).免疫荧光层析法与化学发光分析法进行一致性评价,IgM抗体一致率达84.91％(135/159),IgG一致率达88.68％(141/159),两种方法检测IgG结果的一致性比IgM偏高.检测HIV、结核、系统性红斑狼疮、类风湿性关节炎(RA)和自身免疫性肝炎(HIA)患者血清出现不同程度假阳性,稀释假阳性标本后检测6例RA、2例结核和1例HIA患者SARS-CoV-2抗体转阴.结论 免疫荧光层析法性能满足COIVD-2019临床辅助诊断和流行病学调查,但应注意与流行病不相符的检测结果.通过稀释血清标本,可以一定程度降低检测过程中假阳性,对COIVD-2019患者发病早期标本检测灵敏度的影响需进一步研究.

Objective:To investigate the influence of hepatitis B virus (HBV) combined with human immunodeficiency virus (HIV) infection on the efficacy of anti-retroviral therapy (ART).Methods:The data of 269 HIV-infected patients treated in Chongqing Public Health Medical Center from September 2016 to October 2019 were collected. The patients were divided into HIV monoinfection group and HIV/HBV coinfection group. The changes in liver function, CD4 + T lymphocyte count, and HIV RNA level between the two groups were compared when ART started and at different time points (2, 4, 8, 12, 24, 36, 48, and 96 weeks) after ART started. Statistical analysis were performed by independent sample t test, rank sum test and chi-square test. Results:A total of 145 patients with HIV monoinfection and 124 patients with HIV/HBV coinfection were collected. There were no statistically significant differences in liver function indexes (aspartate aminotransferase ( t=9.566), alanine aminotransferase ( t=-4.652) and total bilirubin ( t=-25.476)) between the two groups of patients when ART started (all P>0.05). At 24, 48 and 96 weeks after ART, the CD4 + T lymphocyte counts in the HIV monoinfection group and the HIV/HBV coinfection group were (305.9±156.9)/μL vs (266.2±172.5)/μL, (388.5±226.1)/μL vs (380.8±287.4)/μL and (369.5±191.4)/μL vs (453.6±179.6)/μL, respectively. At 48, 72 and 96 weeks after ART, the CD4 + T lymphocyte count increasing values were 121.0(-52.5, 144.5)/μL vs 156.0(-35.8, 185.8)/μL, 139.0(-116.0, 176.8)/μL vs 114.5(-59.5, 229.0)/μL and -91.0(-110.0, 153.3)/μL vs -94.0(-130.8, 114.3)/μL, respectively. The differences were all not statistically significant ( t=-0.516, -0.066 and -1.414, Z=-1.715、-0.802 and -1.602, respectively, all P>0.05). At 24, 48, and 96 weeks after ART, the HIV RNA inhibition rates in the HIV monoinfection group were 89.7%(130/145), 96.6%(140/145), and 96.6%(140/145), respectively, and those in the HIV/HBV coinfection group were 87.1%(108/124), 92.7%(115/124) and 94.4%(117/124), respectively. The differences were all not statistically significant ( χ2=0.026, 0.053 and 0.017, respectively, all P>0.05). In the second and fourth weeks after ART, the abnormal liver function rates of the HIV monoinfection group were 3.4%(5/145) and 6.2%(9/145), respectively, which were lower than those in the HIV/HBV coinfection group (21.0%(26/124) and 13.7%(17/124), respectively). The differences were both statistically significant ( χ2=20.121 and 4.309, respectively, both P<0.05). However, the abnormal liver function rates in the two group in the 8th week after ART were 10.3%(15/145) and 9.7%(12/124), respectively, and those in the 12th week were 9.0%(13/145) and 9.7%(12/124), respectively, and those in the 24th week were 9.7%(14/145) and 8.9%(11/124), respectively, and those in the 36th week were 9.7%(14/145) and 10.5%(13/124), respectively, and those in the 48th week were 8.3%(12/145) and 8.1%(10/124), respectively, and those in the 96th week were 2.8%(4/145) and 0(0/124), respectively. The differences were all not statistically significant ( χ2=0.330, 0.040, 0.049, 0.051, 0.004 and 3.472, respectively, all P>0.05). Conclusion:HBV coinfection has no adverse effect on the ART effect of HIV-infected patients.

目的 了解重庆市人类免疫缺陷病毒(HIV)感染者在接受抗反转录病毒治疗后疗效、免疫重建情况及不良事件发生情况.方法 2019年4月至2019年12月,对该中心HIV感染者进行随机问卷调查,并与实验室检测结果匹配.对HIV感染者人口学特征、HIV RNA抑制率、CD4+T淋巴细胞数、重要实验室检查指标的变化进行回顾性分析.结果 共有2049例HIV感染者完成了调查问卷,其中有1205例实验室数据较完整.该研究中,青年男性比例为83.8％,性传播比例达86.4％,其配偶及子女检查率均小于30.0％;第0、24、48、72、96、120、144、168、192、216、240周的CD4+T淋巴细胞数每个微升可达250个左右,病毒学抑制率在90.0％左右;启动抗反转录病毒治疗(ART)后,HIV感染者可出现不同程度的贫血以及肝肾功能异常,以轻中度为主,随着ART时间的延长,异常率越来越低.结论 重庆市HIV感染者ART疗效尚可,"晚发现、晚诊断"现象仍普遍存在,扩大筛查、提高检测覆盖率是控制疾病传播的必要措施.

目的 评价荧光PCR熔解曲线法检测临床标本结核分枝杆菌及其对利福平和异烟肼敏感性的性能.方法 收集重庆市公共卫生医疗救治中心2016年7月至2018年7月进行过荧光PCR熔解曲线法结核检测的病例,分别与结核菌培养和Genexpert比较检测结核菌的灵敏度,与比例法药敏比较药敏结果.结果 在结核菌检测上,荧光PCR熔解曲线法阳性率与结核菌培养相近,低于Genexpert;与比例法药敏相比,检测利福平药敏的灵敏度为93.2％,特异度为80.2％,符合率为84.3％;检测异烟肼药敏的灵敏度为92.6％,特异度为86.3％,符合率为88.6％.结论 荧光PCR熔解曲线法可以高灵敏地直接对临床样本快速检测结核菌及其耐药性.

目的 分析并比较不同类型新型冠状病毒肺炎患者IgM、IgG动态变化特征,为新型冠状病毒肺炎患者的临床诊疗提供循证医学证据并辅助临床医生判断患者病情与病程.方法 对105例新型冠状病毒肺炎住院患者的血清IgM与IgG检查结果进行分析,将患者分为无症状感染者、轻型/普通型和重型/危重型3种类型,分析比较不同类型患者在入院期间IgM与IgG的变化规律.结果 入院时,105例新型冠状病毒肺炎患者的血清IgM阳性率为70.5％,IgG阳性率为74.3％.在4周的治疗期内,轻型/普通型患者血清IgM、IgG阳性率均在80.0％以上,重型/危重型患者血清IgM、IgG阳性率达100.0％,而无症状感染者血清IgM在入院时阳性率为56.1％,而后降低,到治疗4周时阳性率为14.3％.轻型/普通型和重型/危重型患者IgM、IgG阳性率在治疗后的第1、2周高于无症状感染者,差异有统计学意义(P<0.05).轻型/普通型、重型/危重型和无症状感染者在入院时、治疗1、2、3、4周血清IgG、IgM滴度比较,差异有统计学意义(P<0.05).重型/危重型患者血清IgM滴度在入院时、治疗后1、2、3、4周高于无症状感染者,IgG滴度在治疗后1、2、3、4周也高于无症状感染者,差异有统计学意义(P<0.05).结论 不同类型的新型冠状病毒肺炎患者血清IgM、IgG结果有所差异,血清抗体检测可作为核酸检测的重要补充,但不可单独用于疾病诊断和社区筛查.

Objective:To investigate the drug-resistant mutations of human immunodeficiency virus-1 (HIV-1) in patients who received highly active antiretroviral therapy (HAART) from 2014 to 2018.Methods:A total of 880 patients with HIV-1 infection who had been treated with HAART for more than six months in Chongqing Infectious Disease Medical Center from May 2014 to December 2018 were enrolled. Plasma samples were collected, and one-step reverse transcription-polymerase chain reaction (PCR) and nested PCR were taken to amplify protease and reverse transcriptase regions of HIV-1 pol gene region. The obtained amplified nucleotide sequences were compared with the drug resistance database for antiviral drug resistance analysis. Viral genotyping tool software was used to analyze HIV-1 subtype distribution. The categorical variables were compared using chi-square test. Results:Among 880 patients, the plasma HIV-1 viral load was (4.12±0.63) lg copies/mL, the CD4 + T lymphocyte count was (251±124)/μL, and the median duration of antiviral therapy was 26 months. In the subtypes analysis, the circulating recombinant form (CRF) 01-AE subtype was the largest proportion of HIV-1 subtypes, accounting for 38.9%(342/880), and the CRF07-BC subtype accounted for 28.5%(251/880), B+ C subtypes accounted for 16.2%(143/880). Drug-resistant mutations were detected in 534 patients, with a total drug resistance rate of 60.7%. The drug resistance rates of nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) were 51.0%(449/880), 58.6%(516/880) and 1.7%(15/880), respectively. The drug resistances to lamivudine, emtricitabine, efavirenz, and nevirapine were serious, and the medium/high resistance rates were 46.8%(412/880), 46.8%(412/880), 51.3%(451/880), and 53.6%(472/880), respectively, while those to zidomidudine (6.0%, 53/880), etravirin (9.0%, 451/880) and PI were not serious. M184IV (47.3%), K65R (22.2%) and K70RE (12.6%) were the most frequent mutations for NRTI. K103NS (25.1%), V106A (19.7%) and V179DE (14.4%) were the most frequent mutations for NNRTI. The most common drug-resistant mutations for PI were L10FIV (7.4%) and A71IVT (6.5%). The drug resistance rate of CRF01-AE subtype (69.3%, 237/342) was higher than those of CRF07-BC subtype (49.8%, 125/251) and B+ C subtype (51.0%, 73/143), the differences were statistically significant ( χ2=22.6 and 14.6, respectively, both P<0.05). Conclusions:The incidence of drug resistance is high among HIV-1 infected patients after six-month HAART treatment in Chongqing City. The drug resistance to NNRTI is the most common, followed by NRTI, while PI is less resistant. Drug resistance is the main reason for the virological breakthrough in HIV-1 infected patients.

目的 评估MPB64免疫胶体金法、PNB试验和Xpert MTB/RIF在结核分枝杆菌(Mycobacterium tuberculosis,MTB)和非结核分枝杆菌(non-tuberculous mycobacterium,NTM)鉴定中的应用价值.方法 收集2017年5～11月在重庆市公共卫生医疗救治中心就诊经分枝杆菌菌种鉴定(PCR-反向点杂交法)诊断的肺结核或疑似肺结核病人BACTECMGIT960培养阳性标本178份,分别用MPB64胶体金法、PNB试验和Xpert MTB/RIF鉴定MTB和NTM,以PCR-反向点杂交法的鉴定结果为金标准,比较3种方法的敏感度和特异度.结果 PCR-反向点杂交法鉴定结果为154株MTB,6株MTB与NTM混合感染,18株NTM.PNB试验、Xpert MTB/砌F试验、胶体金试验鉴定MTB的敏感度分别为96.1％、100.0％、96.7％,3种方法的敏感度差异有统计学意义(P＜0.05);PNB试验、Xpert MTB/砌F试验、胶体金试验鉴定MTB的特异度分别为88.8％、100.0％、100.0％,检测结果特异度之间差异无统计学意义(P＞0.05).结论 3种方法均可用于MTB和NTM的鉴定,Xpert MTB/RIF和胶体金MPB64更适用于MTB的快速初步鉴定.

Objective:To analyze the distribution and drug sensitivity of pathogens and cerebrospinal fluid (CSF) related measurements in AIDS patients with central nervous system (CNS) infections in Chongqing, so as to provide guidance for etiological diagnosis and rational use of antibiotics in AIDS patients with CNS infections.Methods:A total of 173 AIDS patients with CNS infections were divided into fungal group, Gram-positive bacilli group, Gram-positive cocci group and Gram-negative bacilli group. During the same period, 198 AIDS patients with non-CNS infection visited this hospital were enrolled into the control group. CSF and blood were collected for bacterial culture. The composition and drug resistance of pathogens were analyzed. The levels of CSF related measurements were determined and compared.Results:A total of 173 strains of pathogens were isolated from the CSF of the AIDS patients with CNS infections. The 173 strains included 101 (58.38%) fungi, 39 (22.54%) Gram-positive bacilli, 24 (13.87%) Gram positive cocci and 9 (5.20%) Gram-negative bacilli; 230 strains of pathogens were isolated from the blood of the AIDS patients with non CNS infections. The 198 strains were composed of 107(54.04%) fungi, 65 (32.83%) Gram positive cocci and 26 (13.13%) Gram-negative bacilli. Antifungal sensitivity testing result of Cryptococcus neoformans showed that MIC of amphotericin B, fluorocytosine, fluconazole, voriconazole and itraconazole were≤4, ≤32, ≤8, ≤1 and ≤1 μg/ml. The resistance rate of Mycobacterium tuberculosis to rifampicin was 7.69%. The result of drug sensitivity of coagulase negative staphylococci isolated from patients with CNS infections and non-CNS infections were consistent. There were significant differences among Staphylococcus aureus, Enterobacteriaceae and Acinetobacter. Compared with the control group, the levels of protein were higher and the levels of chloride and glucose were lower in fungal group, Gram-positive bacteria group, Gram-positive coccus group and Gram-negative bacteria group ( t=3.408-9.249, all P<0.011). The levels of protein, adenosine deaminase (ADA) and lactic dehydrogenase (LDH) in Gram-positive bacilli group were significantly higher than those in fungal group, Gram-positive coccus group, Gram-negative bacteria group and control group ( t=3.836-7.686, all P<0.037). Conclusions:The pathogens causing CNS and blood infections in AIDS patients were widely distributed, mainly dominated by fungus. The CSF related measurements varied with different pathogens, so as to assist in the etiological diagnosis of CNS infections.

目的 探讨Xpert HIV-1病毒载量(Xpert HIV-1 VL)检测用于HIV-1病毒载量检测的临床价值.方法 采用Xpert HIV-1 VL和Abbott m2000 Real Time检测系统(Abbott m2000)同时检测191份血浆样本的HIV-1病毒载量.采用符合率、卡方检验和Kappa值等统计分析两种检测方法定性检测结果的一致性,采用相关性、回归分析和Bland-Altman模型等统计分析两种检测方法定量检测结果的一致性.结果 两种检测方法的阳性符合率、阴性符合率和总符合率均为100％,两种方法检测结果一致性分析的Kappa值为1.00 (P＜0.001);两种方法检测结果的相关系数为0.957 6,回归分析表现出较高的相关性(R2=0.917 0),Bland-Altman模型分析显示两种方法检测有95.3％ (164/172)的样本在95％一致性界限内.结论 Xpert HIV-1 VL用于检测HIV-1 RNA具有很高的灵敏度、准确性和稳定性,且操作简单、方便、安全,适合临床用于对HIV-1患者血浆样本中HIV-1 RNA的检测.

目的 研究分析获得性免疫缺陷综合征(AIDS)患者血浆和脑脊液中人类免疫缺陷病毒(HIV)病毒载量之间的关系.方法 选取175例AIDS患者配对的血浆和脑脊液标本,检测HIV RNA病毒载量,进行统计分析.结果 在175例患者中,血浆和脑脊液病毒载量的中位数分别为4.99 lg copies/mL和3.42 lg cop-ies/mL,χ2=21089.21,P<0.01.血浆和脑脊液病毒载量检测结果 一致率为84.0％,不一致率为16.0％,经检验χ2校正=60.86,P<0.01.血浆分为高中低病毒载量3组,对应的脑脊液病毒载量阳性率比较(F=92.344,P<0.01).结论 血浆中的HIV RNA病毒载量高于脑脊液.血浆和脑脊液中HIV RNA病毒载量的检测结果 存在较高的一致性,维持人体血浆低病毒载量对延缓颅脑感染HIV有积极保护的作用.

目的 分析2019年4月在南美圭亚那合作共和国集体发病的10例急性组织胞浆菌病中国籍患者的临床特点,总结治疗方案.方法 对10例急性组织胞浆菌病患者的住院与随访资料进行分析.结果 10例均为青中年男性,年龄30～56岁,平均(44±8)岁;4例从事清理积土工作,2例气割作业,2例搬运工具,2例巡视.暴露时间0.2～96.0 h;潜伏期9～13 d,平均(11±1)d.以发热、头昏、头痛、乏力、纳差、咳嗽、皮疹、腹泻为主要临床表现.胸部CT表现为双肺多发结节影,以胸膜下及双肺下叶分布明显;结节周围可见晕征;少数患者可出现实变影.1例诊断为急性播散型组织胞浆菌病,9例诊断为急性肺型组织胞浆菌病.住院使用两性霉素B脂质体,起始剂量每天0.7～1.2 mg/kg,平均每天(0.8±0.2)mg/kg;最高剂量每天1.1～2.0 mg/kg,平均每天(1.4±0.3)mg/kg.使用时间4～54 d.出院使用伊曲康唑10～161 d、伏立康唑口服治疗5～7个月.9例临床症状消失,1例植物人状态.复查胸部CT显示肺部病灶均明显吸收.结论 急性组织胞浆菌病的临床和影像学表现有一定特点.确诊需结合流行病学史、临床、影像、实验室及病理检查.两性霉素B脂质体作为该病中、重度患者的强化治疗药物是有效的,但最高剂量小于美国感染病学会(IDAS)推荐剂量.序贯使用伊曲康唑与伏立康唑治疗均有效.

马红球菌(rhodococcus equi)是一种弱抗酸性的革兰阳性球杆菌,有报道马红球菌感染合并艾滋病病毒(HIV)感染者、器官移植接受者和接受恶性肿瘤化疗、皮质类固醇或抗TNF抗体治疗的患者[1].本文通过回顾一例在本院感染科诊治的HIV感染耐药患者合并播散性马红球菌感染的特点,复习相关文献,总结并分析该病的病例特点、细菌鉴定和治疗情况,以期给临床诊断和治疗病原菌提供依据.

为评价SARS-CoV-2特异性IgM和IgG抗体检测在2019-冠状病毒病(corona virus disease 2019,COVID-19)中的临床应用价值.本试验采用回顾性研究方法,选择重庆市公共卫生医疗救治中心2020年2月4-24日门诊和住院患者作为研究对象,其中COVID-19患者101例,排除COVID-19的其他肺部疾病及发热患者54例作为对照组,以RT-PCR检测结果作为金标准,采用胶体金免疫层析法(gold immunochromatography assay,GICA)检测所有研究对象的SARS-CoV-2特异性IgM和IgG抗体,使用诊断特异性、敏感度、诊断准确度等指标对诊断价值进行评价,并分析抗体与疾病病程以及疾病分型的关系,采用χ2检验对检测结果进行统计学分析.结果表明,SARS-CoV-2特异性IgM/IgG临床诊断敏感度、特异度和诊断准确度分别为92.1％,90.7％和91.6％,与RT-PCR方法相比,经过χ2检验,二者差异无统计学意义(p>0.05).SARS-CoV-2特异性IgM和IgG抗体阳性率与病程的关系经过χ2检验,不同发病天数各组间差异有统计学意义(p>0.05).不同疾病分型的SARS-CoV-2特异性IgM和IgG抗体阳性率经过χ2检验,差异无统计学意义(p>0.05).总之,SARS-CoV-2特异性IgG/gM抗体的检测可用于COVID-19感染的诊断,但在疾病早期可能存在漏检的风险.

目的 分析重庆市耐多药结核分枝杆菌(multidrug-resistant Mycobacterium tuberculosis,MDR-TB)对贝达喹啉(bedaquiline,Bdq)和德拉马尼(delamanid,Dlm)的药物敏感性,以期为临床上Bdq和Dlm的合理使用提供参考.方法 收集2017年11月至2018年11月间经重庆市公共卫生医疗救治中心鉴定为MDR-TB的菌株,采用微孔板法测定Bdq和Dlm的最低抑菌浓度(minimum inhibitory concentration,MIC),并对相关结果进行分析.结果 所收集的111例MDR-TB临床分离株进行Bdq的药敏检测结果显示,MIC50和MIC90分别为0.016mg/L和0.125 mg/L;109例MDR-TB菌株的Dlm药敏结果显示,MIC50和MIC90分别为0.016 mg/L和0.063 mg/L.各有5株菌株对Bdq和Dlm耐药,耐药率分别为4.50％和4.59％.不同耐药情况分组对Bdq和Dlm的耐药率与MDR-TB菌株对Bdq和Dlm的耐药率之间差异无统计学意义(P＞0.05).结论 重庆市大部分MDR-TB菌株对这两种新的抗结核药物非常敏感,但不应忽视原发耐药,在制定临床治疗方案时,仍需重视对新药的药敏检测.

目的 探讨分析重庆市非结核分枝杆菌(N T M)的流行趋势和耐药情况.方法 对2016年1月至2017年12月该中心结核实验室分离培养的N T M相关结果 进行统计分析.结果2016-2017年分离培养的4965例分枝杆菌中结核分枝杆菌4682例,N T M 283例,N T M分离率为5.70％.痰和纤支镜灌洗液中分离到的NTM最多.男性NTM感染者多于女性,比例为1.77:1,发病年龄主要集中于20～60岁.耐药比例最高者为异烟肼、力克肺疾和对氨基水杨酸,高耐药比例均超过90.00％.最敏感的药物为克拉霉素,敏感率超过70.00％.乙胺丁醇、莫西沙星和利福布丁的高耐药比例呈现下降趋势,而利奈唑胺的敏感比例明显下降,而高耐药比例则明显上升.结论 重庆市NTM分离率低于全国平均水平,感染人群多为青壮年,且耐药率高.应加强实验室分子诊断和药敏试验的能力和水平,更好地控制结核与NTM感染.

为比较分析耐多药结核分枝杆菌(MDR-MTB)对利奈唑胺(Lzd)和特地唑胺(Tzd)的药物敏感性,笔者采取直接抽选法选取2018年1-11月间重庆市公共卫生医疗救治中心中心实验室培养分离并经药物敏感性试验(简称“药敏试验”)鉴定为MDR-MTB的40株菌株,采用微孔板法测定Lzd和Tzd的最低抑菌浓度(MIC),并分析相关结果.结果 发现,Lzd对MDR-MTB的MIC的中位数(四分位数)为0.500 (0.500,1.000) mg/L,其中87.5％(35/40)的菌株MIC处于0.500～1.000 mg/L;Tzd对MDR-MTB的MIC的中位数(四分位数)为0.250(0.250,0.250) mg/L,其中87.5％(35/40)的菌株MIC处于0.125～0.250 mg/L.Lzd对MDR-MTB的MIC50和MIC90分别为0.500、1.000 mg/L;Tzd对MDR-MTB的MIC50和MIC90均为0.250mg/L.Tzd的MIC明显小于Lzd的MIC,差异有统计学意义(Z=-5.51,P＜0.001).参照比例法药敏试验结果,40株MDR-MTB临床分离株可分为13株MDR-MTB,20株前广泛耐药结核分枝杆菌(pre-XDR-MTB)和7株广泛耐药结核分枝杆菌(XDR-MTB).Lzd对MDR-MTB、pre-XDR-MTB、XDR-MTB菌株的MIC中位数(四分位数)均为0.500(0.500,1.000) mg/L;Tzd对MDR-MTB、pre-XDR-MTB菌株、XDR-MTB菌株的MIC中位数(四分位数)均为0.250(0.250,0.250) mg/L,差异均无统计学意义(Lzd:H=0.84,P=0.659;Tzd:H=0.59,P=0.746).可见,Lzd和Tzd对MDR-MTB菌株均有很好的杀菌效果,Tzd具有较Lzd更好的抗结核效果.

Objective To analyze the prevailing species nontuberculosis mycobacteria and infected population characteristics in Chongqing.Methods The relative data of the patients who were diagnosed by PCR-reverse dot blot hybridization as NTM infected in Chongqing Infection Disease Medical Center during July 2016 to December 2017 were analyzed retrospectively.Results Among 95 NTM infected strains,80 strains were single infection and 15 strains were mixed infection.In 80 single infection strains,there were 2 species of RGM and 5 species of SGM.RGM were Mycobacterium abscessus(31 strains,38.75%)and Mycobacterium fortuitum/porcinum(14 strains,17.50%).SGM were Mycobacterium intracellulare(25 strains,31.25%),Mycobacterium avium(5 strains,6.25%),Mycobacterium gordonae(3 strains,3.75%),Mycobacterium kansasii(2 strains,2.50%).In the 15 mixed infected strains,11 strains were co-infected with TB and NTM;4 strains were two species NTM co-infected.The male patients infected with single NTM were more than the female patients.The gender ratio(male:female)of mix infected patients was nearly 1∶1.The gender ratio(male:female)of Mycobacterium intracellulare infected patients was highest.Single NTM infected patients were major in the ages of 20-<30 and 40-<60,while TB and NTM co-infected patients were most common between the ages of 30-<50.Mycobacterium abscessus infected patients were mainly between 20-<60 years old,and Mycobacterium intracellulare infected patients were mainly distributed among 40-<79 years old.Patients infected by Mycobacterium fortuitum/porcine were mainly under 60 years old.Conclusion Mycobacterium abscessus and Mycobacterium intracellulare were the main prevalent species of NTM in Chongqing.The male NTM infected patients were more than that of the female.NTM infected patients were major in the ages of 20-29 and 40-59.For different species NTM,the age distribution and gender ratio of the infected patients were not the same.

目的 了解重庆市结核病患者利福平(rifampicin,RFP)耐药与耐多药的相关程度,为重庆市RFP耐药及耐多药结核病患者的准确诊断和及时治疗提供科学依据.方法 收集重庆市公共卫生医疗救治中心2017-2019年收治的培养阳性且鉴定为结核分枝杆菌的患者菌株,进行以下十种抗结核药物的药敏试验:RFP、异烟肼(isoniazid,INH)、链霉素、乙胺丁醇、氧氟沙星、卡那霉素、阿米卡星、卷曲霉素、对氨基水杨酸和丙硫异烟胺.共收集菌株937例,分析其RFP和INH耐药情况.结果 937例菌株中,RFP耐药菌株288例,RFP耐药INH敏感菌株比例为20.14％ (58/288);RFP敏感菌株为649例,其中INH耐药菌株占比7.09％(46/649).重庆市耐多药患者比例为24.55％,广泛耐药肺结核患者占比2.99％.无论RFP耐药还是RFP敏感菌株中,INH耐药或敏感的患者在年龄、性别和治疗史方面差异均无统计学意义.结论 重庆市RFP耐药结核病患者中有较高比例为异烟肼敏感患者,RFP耐药不适合作为重庆地区耐多药患者确诊的指标,应采取有效手段同时检测RFP和INH耐药情况,以指导临床医生为结核病患者制定合理的化疗方案,推动重庆市结核病防治工作的进展.