576份胸腔积液样本结核分枝杆菌培养阳性率及14种药物敏感性分析

doi:10.19871/j.cnki.xfcrbzz.2025.05.001

摘要/Abstract

摘要： 目的基于BS1000全自动结核分枝杆菌培养仪和多种技术联合,探究576份胸腔积液样本中结核分枝杆菌的阳性检出率,并采用最低抑菌浓度（minimum inhibitory concentration,MIC）法测定14种抗结核药物敏感性,为临床实践提供科学依据。方法采用BS1000全自动结核分枝杆菌培养仪对2024年1月–12月广西壮族自治区胸科医院临床送检的576例腔积液样本进行培养检测。培养阳性样本经智能扫描与优化涂染技术确认抗酸杆菌阳性后,通过抗原检测和传统的对硝基苯甲酸（p-nitrobenzoic acid,PNB）法进行菌种鉴定,并采用MIC法对结核分枝杆菌分离株进行14种抗结核药物的敏感性检测,统计分析结核分枝杆菌的检出率及耐药特点。结果 576份胸腔积液样本共分离出88株结核分枝杆菌菌株,检出率15.5%（88/576）,不同临床诊断患者的胸腔积液结核分枝杆菌培养阳性率差异具有统计学意义（χ2=25.6,P=0.001）,肺部阴影患者阳性率最高（22.6%）,肺癌（5.3%）和肺外结核（5.5%）等疾病患者阳性率较低。88株结核分枝杆菌的总耐药率为21.6%（19/88）,链霉素耐药率最高（7.9%）,乙胺丁醇、利福布汀等6种药物未检出耐药菌株。一线药物中,乙胺丁醇未检出耐药菌株;二线药物中,左氧氟沙星和阿米卡星等未检出耐药菌株;多耐药以含链霉素耐药为主。结论胸腔积液结核分枝杆菌检出率与临床诊断相关,菌株药物耐药性复杂,临床需依病症及耐药特征用药,制定个性化方案,并加强链霉素等高危药物监测。

关键词: 胸腔积液, 结核分枝杆菌, 多技术, 检出率, 耐药率

Abstract: Objective Based on the BS1000 fully automatic Mycobacterium tuberculosis culture instrument and a combination of multiple technologies, this study explored the positive detection rate of Mycobacterium tuberculosis in 576 pleural effusion samples, and applied the minimum inhibitory concentration(MIC) method to determine the sensitivity of 14 anti-tuberculosis drugs, thereby providing a scientific basis for clinical practice. Method The BS1000 fully automatic Mycobacterium tuberculosis culture instrument was used to culture and detect 576 samples of pleural effusion clinically submitted for examination between January and December 2024 at the Chest Hospital of Guangxi Zhuang Autonomous Region. After the acid-fast bacilli in the positive culture samples were confirmed using intelligent scanning and optimized staining technology, the strains were identified through antigen detection and the traditional p-nitrobenzoic acid (PNB) method. The MIC method was used to detect the sensitivity of 14 anti-tuberculosis drugs for the Mycobacterium tuberculosis isolates, and the detection rate and drug-resistance characteristics of Mycobacterium tuberculosis were statistically analyzed. Result Mycobacterium tuberculosis strains were isolated from 88 of the 576 pleural effusion samples, with a detection rate of 15.5% (88/576). There was a statistically significant difference was observed in the positive rate of Mycobacterium tuberculosis culture in pleural effusion among patients with different clinical diagnoses (χ2=25.6, P=0.001). The highest positive rate was observed in patients with pulmonary shadows (22.6%), while the positive rates were relatively low among patients with diseases such as lung cancer (5.3%) and extrapulmonary tuberculosis (5.5%). The total drug resistance rate of 88 Mycobacterium tuberculosis strains was 21.6% (19/88). The drug resistance rate to streptomycin was the highest (7.9%), and no drug-resistant strains were detected against six drugs including ethambutol and rifabutin. Among first-line drugs, no resistant strains were detected for ethambutol; among second-line drugs, no resistant strains were detected for levofloxacin, amikacin, and multi-drug resistance was mainly characterized by streptomycin inclusion. Conclusion The detection rate of Mycobacterium tuberculosis in pleural effusion was associated with clinical diagnosis. In clinical practice, drugs should be selected according to the disease condition and drug-resistance characteristics, and personalized treatment plans should be developed. In addition, the monitoring of high-risk drugs such as streptomycin should be strengthened.

Key words: Pleural effusion, Mycobacterium tuberculosis, Multiple technologies, Detection rate, Drug resistance rate

中图分类号:

R52
R378.91

唐柳生, 董捷, 蒙雪佳, 曾庆雪, 刘爱梅. 576份胸腔积液样本结核分枝杆菌培养阳性率及14种药物敏感性分析[J]. 新发传染病电子杂志, 2025, 10(5): 1-5.

Tang Liusheng, Dong Jie, Meng Xuejia, Zeng Qingxue, Liu Aimei. Analysis of the positive rate of Mycobacterium tuberculosis culture in 576 cases of pleura effusion and the sensitivity of 14 kinds of drugs[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(5): 1-5.

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