本文選題：兒童 + 分枝桿菌�。� 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：第一部分218株分枝桿菌菌種鑒定和藥物敏感性分析 目的：了解我院住院結(jié)核病患兒所感染分枝桿菌的菌種和對4種常用抗結(jié)核藥物的耐藥情況，為臨床的治療提供實(shí)驗(yàn)數(shù)據(jù)。 方法：將2008年02月-2013年12月期間我院住院結(jié)核病患兒的體液標(biāo)本進(jìn)行分離培養(yǎng)，培養(yǎng)陽性所得菌株用分枝桿菌藥敏羅氏培養(yǎng)基行菌種初步鑒定及對利福平、異煙肼、鏈霉素、乙胺丁醇4種抗結(jié)核藥物的耐藥性試驗(yàn)。 結(jié)果：218株分枝桿菌中，結(jié)核分枝桿菌為199株（91.5%），牛型分枝桿菌為17株(7.8%)，非結(jié)核分枝桿菌菌群為2株(0.9%)。總耐藥株數(shù)67株（30.7%），耐多藥株數(shù)14例（6.4%）。四種抗結(jié)核藥物的耐藥率從高到低依次為SM21.6%（47/218）、INH14.2%（31/218）、EMB11.5%（25/218）、RFP6.9%（15/218）。 結(jié)論：我院住院結(jié)核病患兒中存在耐藥情況，且近年來有上升趨勢。 第二部分兒童結(jié)核病耐藥的危險(xiǎn)因素及預(yù)后分析 目的：分析我院結(jié)核病患兒耐藥的危險(xiǎn)因素及耐藥結(jié)核病的預(yù)后。 方法：將2008年02月至2013年12月在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院住院的患兒中結(jié)核培養(yǎng)陽性并成功進(jìn)行藥物敏感試驗(yàn)的198例患兒做為研究對象，根據(jù)藥敏試驗(yàn)結(jié)果分為敏感組、耐藥組、耐多藥組。對198例患兒的流行病學(xué)及臨床資料進(jìn)行回顧性分析，耐藥組和耐多藥組分別與敏感組進(jìn)行比較，采用卡方檢驗(yàn)，對P＜0.05的研究因素行Logistic回歸分析，以了解我院結(jié)核病患兒耐藥、耐多藥的危險(xiǎn)因素。對所有病例進(jìn)行電話隨訪，了解耐藥及耐多藥患兒的預(yù)后情況。 結(jié)果：198例患兒中男性115例，女性83例，男：女為1.4:1。最小年齡25日齡，最大年齡16歲10月，平均6.20±5.15歲。城鎮(zhèn)和農(nóng)村患兒分別為71例（35.9%）、127例（64.1%）。有卡疤和無卡疤患兒分別為127例(64.1%)、71例(35.9%)。有結(jié)核病人接觸史的85例（42.9%），否認(rèn)有接觸史的113例(57.1%)。入院前病程≤1月者151例（76.3%），＞1月者47例（23.7%）。播散型結(jié)核病80例(40.4%)，非播散型結(jié)核118例（59.6%）。胸廓內(nèi)結(jié)核80例（40.4%），胸廓外結(jié)核118例（59.6%）。體重低下者48人（24.2%），無體重低下者150人（75.7%）。合并貧血患兒105例（53.0%），，無貧血患兒93例（48.0%）。194例標(biāo)本行涂片找抗酸桿菌，涂片陽性88例（45.4%），涂片陰性106例(54.6%)。上述研究因素中，敏感組和耐藥組在涂片找抗酸桿菌上有顯著差異（P=0.01，OR=0.338）；敏感組和耐多藥組在入院前病程（P=0.026，OR=4.417）、感染播散性（P=0.012，OR=7.638）等方面有顯著差異。耐藥組和耐1種藥物組在治療效果上無統(tǒng)計(jì)學(xué)差異（P=0.947），敏感組和耐≥2種藥物組在治療效果上有顯著統(tǒng)計(jì)學(xué)差異（P=0.000）。 結(jié)論：敏感組和耐藥組在涂片找抗酸桿菌陽性上有顯著差異。入院前病程和感染的播散性為耐多藥結(jié)核病的危險(xiǎn)因素。兒童耐藥結(jié)核病的療效差，病死率高。
[Abstract]:Part I Identification of 218 strains of Mycobacterium and Analysis of Drug sensitivityObjective: to investigate the mycobacterium species and resistance to four commonly used antituberculous drugs in children with tuberculosis in our hospital, and to provide experimental data for clinical treatment.Methods: from February 2008 to December 2013, the body fluid samples of children with tuberculosis in our hospital were isolated and cultured. The positive strains were identified with Mycobacterium drug sensitive Roche medium and rifampicin, isoniazid and streptomycin were identified.Drug resistance test of 4 antituberculous drugs with ethambutanol.Results among the Mycobacterium species, 199 strains were Mycobacterium tuberculosis, 17 strains were Mycobacterium bovis, and 2 strains were non-tuberculous.The total number of resistant strains was 37. 7 and the number of multi-resistant plants was 6. 4% in 14 cases.The drug resistance rates of the four antituberculous drugs ranged from high to low as follows: SM21.6and 47 / 218and INH14.2N / 31 / 218B / EMB11.5a / 25 / 218r-RFP6.9and 15 / 218g / 218g respectively.Conclusion: drug resistance exists in children with tuberculosis in our hospital, and it is increasing in recent years.Analysis of risk factors and prognosis of Drug Resistance in Children with TuberculosisObjective: to analyze the risk factors and prognosis of drug resistance in children with tuberculosis.Methods: 198 children in Chongqing Medical University affiliated Children's Hospital from February 2008 to December 2013 were divided into sensitive group according to the results of drug sensitivity test.Drug resistance group, multi-drug resistance group.The epidemiological and clinical data of 198 children were analyzed retrospectively. The drug resistance group and the multidrug resistance group were compared with the sensitive group respectively. The chi-square test was used to analyze the factors (P < 0. 05) and the Logistic regression analysis was performed to understand the drug resistance of children with tuberculosis in our hospital.Risk factors for multidrug resistance.All patients were followed up by telephone to understand the prognosis of drug-resistant and multi-drug-resistant children.Results among the 198 children, 115 were male and 83 were female. The ratio of male to female was 1.4: 1.The minimum age was 25 days and the maximum age was 16 years old in October, with an average of 6.20 鹵5.15 years old.There were 71 cases in town and 127 cases in countryside.127 cases (64.1%) with and without scar were diagnosed and 71 cases (35. 9%) were diagnosed.85 cases with history of contact with tuberculosis and 113 cases with no history of exposure were found to be 57.1%.The course of disease before admission was less than one month in 151 cases with 76.3% and > one month in 47 cases.There were 80 cases of disseminated tuberculosis and 118 cases of non-disseminated tuberculosis.There were 80 cases of intrathoracic tuberculosis and 118 cases of extrathoracic tuberculosis.48 people with low weight and 150 people without low weight had 75. 75.75%.105 cases with anemia and 93 cases without anemia were examined for acid-fast bacillus by smear, 88 cases with positive smear and 106 cases with negative smear and 54.6 cases with negative smear.Among the above factors, there were significant differences between sensitive group and drug resistant group in finding acid-fast bacilli on smear. There were significant differences between sensitive group and multidrug resistance group in the course of disease before admission, P0.026 ORP 4.417, infection and spread of P0. 012, OR7. 638).There was no significant difference in the therapeutic effect between the resistant group and the drug resistant group (P0. 947), but there was significant difference between the sensitive group and the resistant group (P 0. 000).Conclusion: there is significant difference between sensitive group and drug resistant group in finding acid-fast bacillus in smear.The course of disease and the spread of infection were risk factors of MDR tuberculosis before admission.Children with drug-resistant tuberculosis have poor efficacy and high mortality.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R529.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 彭哲;劉芮汐;李奇志;幸琳琳;朱朝敏;;兒童結(jié)核病耐藥狀況及危險(xiǎn)因素分析[J];中國微生態(tài)學(xué)雜志;2011年07期

2 李亮,端木宏謹(jǐn);1979～2000年四次全國兒童結(jié)核病流行病學(xué)抽樣調(diào)查分析[J];中華醫(yī)學(xué)雜志;2004年20期

本文編號(hào)：1751774