本文選題：結(jié)核分枝桿菌 + 莫西沙星　； 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：目的：研究結(jié)核分枝桿菌（MTB）對莫西沙星（MFX）、左氧氟沙星（LFX）和氧氟沙星（OFX）三種臨床常用氟喹諾酮類藥物的敏感性，分析其耐藥狀況，為臨床用藥提供依據(jù)。同時探討耐多藥肺結(jié)核患者的血清TNF-α、IFN-γ變化及意義。 方法：采用比例法對莫西沙星和異煙肼（INH）、鏈霉素（SM）、利福平（RFP）、乙胺丁醇（EMB）、氧氟沙星（OFL）、左氧氟沙星（LVF）、環(huán)丙沙星（CIP）、丙硫異煙胺（TH1321）、對氨基水楊酸（PAS）、阿米卡星（Am）分別做藥物敏感性試驗。根據(jù)藥物敏感性試驗結(jié)果、采用雙抗體夾心ELASA方法測定耐多藥肺結(jié)核患者血清TNF-α、IFN-γ的變化。 結(jié)果：（1）750例肺結(jié)核患者痰標(biāo)本中，培養(yǎng)法共檢出陽性標(biāo)本376例，其中，莫西沙星有64株發(fā)生耐藥，耐藥率為17.0%；異煙肼60.6%、鏈霉素44.1%、利福平51.5%、乙胺丁醇42.0%、氧氟沙星37.6%、左氧氟沙星25.0%、丙硫異煙胺52.1%、對氨基水楊酸56.9%、環(huán)丙沙星66.5%、阿米卡星44.1%。 （2）耐多藥肺結(jié)核患者的血清TNF-α、IFN-γ顯著高于敏感組（P＜0.05）。耐多藥肺結(jié)核患者血清TNF-α的檢測結(jié)果顯示隨著病灶范圍增加TNF-α的水平減少，1~2肺野組TNF-α的水平明顯高于5~6肺野組（P＜0.01）；無空洞組血清TNF-α平均值高于有空洞組（P＜0.05）。耐多藥肺結(jié)核病人的血清IFN-γ的檢測結(jié)果顯示5~6個肺野組比3~4肺野組高（P＜0.05）。 結(jié)論： （1）耐藥結(jié)核病的發(fā)生除了與結(jié)核分枝桿菌產(chǎn)生耐藥性有關(guān)以外，免疫功能紊亂是另一重要因素，，耐多藥結(jié)核病患者結(jié)核分枝桿菌在機(jī)體內(nèi)引起較強(qiáng)烈地免疫反應(yīng)，導(dǎo)致外周血中TNF-α、IFN-γ水平變化，這些細(xì)胞因子在結(jié)核病的發(fā)病過程中起著一定的作用，而且與病情嚴(yán)重程度密切相關(guān)。 （2）目前在結(jié)核分枝桿菌藥物敏感性試驗中，氧氟沙星和左氧氟沙星已出現(xiàn)較高的耐藥率,值得臨床醫(yī)生重視。莫西沙星顯示出良好的抗菌效果，是一種有效的抗結(jié)核藥物，給耐藥結(jié)核病的治療帶來希望。使用時亦應(yīng)做結(jié)核菌敏感性測試，了解其耐藥情況，科學(xué)指導(dǎo)臨床進(jìn)行有針對性的治療措施。
[Abstract]:Objective: to study the sensitivity of Mycobacterium tuberculosis (MTB) to three kinds of commonly used fluoroquinolones (MFX), levofloxacin (LFX) and ofloxacin (OFX). To explore the change and significance of serum TNF- 偽 and IFN- 緯 in multidrug resistant pulmonary tuberculosis patients. Methods: the sensitivity of moxifloxacin, isoniazid, streptomycin, rifampicin, EMBO, ofloxacin, levofloxacin, ciprofloxacin, TH1321, aminosalicylate PASN and amicacin Amm were tested by proportional method. According to the results of drug sensitivity test, the changes of serum TNF- 偽 and IFN- 緯 in patients with multidrug resistant pulmonary tuberculosis were determined by double antibody sandwich ELASA method. Results out of 750 sputum samples of Pulmonary tuberculosis patients, 376 positive samples were detected by culture method. Among them, 64 strains were resistant to moxifloxacin. Isoniazid 60.6, streptomycin 44.1, rifampicin 51.5, ethambutanol 42.0, ofloxacin 37.6um, levofloxacin 25.0, propyl isoniacin 52.1, p-aminosalicylic acid 56.9, ciprofloxacin 66.5, amikacin 44.1. (2) the serum TNF- 偽 IFN- 緯 level in multidrug resistant pulmonary tuberculosis patients was significantly higher than that in sensitive group (P < 0.05). The results of serum TNF- 偽 detection in multidrug resistant pulmonary tuberculosis patients showed that the level of TNF- 偽 in the lung field group was significantly higher than that in the lung field group (P < 0.01) and the mean value of TNF- 偽 in the non-cavity group was higher than that in the empty group (P < 0.05). The results of serum IFN- 緯 detection in multidrug resistant pulmonary tuberculosis patients showed that the levels of IFN- 緯 in 5 ~ 6 lung field group were higher than those in 3 ~ 4 lung field group (P < 0. 05). Conclusion: 1) the occurrence of drug-resistant tuberculosis (MDR-TB) is not only related to the drug resistance of Mycobacterium tuberculosis, but also to the disorder of immune function. The mycobacterium tuberculosis in MDR-TB patients causes a stronger immune response in the body. These cytokines play a certain role in the pathogenesis of tuberculosis and are closely related to the severity of the disease. At present, ofloxacin and levofloxacin have a high drug resistance rate in Mycobacterium tuberculosis drug sensitivity test, which is worthy of attention by clinicians. Moxifloxacin shows good antibacterial effect and is an effective anti-tuberculosis drug, which brings hope to the treatment of drug-resistant tuberculosis. The sensitivity test of tuberculous bacilli should be done to understand the drug resistance of tuberculous bacilli and to guide the clinical treatment scientifically.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R521

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