结核分枝杆菌L型感染对结核病患者痰菌阴转率的影响

目的分析深圳市罗湖辖区结核病患者结核分枝杆菌（Mycobacteriumtuberculosis，MTB）及其L型（MTB—L）的感染状况，探讨MTB—L感染对结核病患者痰菌阴转率的影响。方法采用抗酸染色法检测辖区内2010—2011年收治的960例结核病确诊患者（初治916例、复治44例）的痰液标本并分析其治疗期间MTB和MTB—L的阳性检出率。计算结核病痰菌涂阳患者2、3月末痰菌阴转率，比较MTB阳性、MTB＋MTB．L阳性以及MTB．L阳性患者痰菌阴转率的差异。结果916例初治患者中MTB阳性患者411例、MTB＋MTB．L阳性患者130例、MTB-L阳性患者129例，初治结核病患者中MTB阳性患者2、3月末痰菌阴转率（90．3％、99．5％）均分别高于MTB＋MTB-L阳性患者（46．9％、89．2％）及MTB-L阳性患者（45．7％、89．1％），差异均有统计学意义（Pl〈0．05）；而MTB＋MTB-L阳性患者2、3月末痰菌阴转率与MTB-L阳性患者比较差异均无统计学意义（尸〉0．05）。44例复治结核病患者中MTB阳性患者12例、MTB＋MTB-L阳性患者19例、MTB-L阳性患者13例，MTB阳性患者2月末痰菌阴转率（83．3％）分别高于MTB＋MTB-L阳性患者（42．1％）及MTB．L阳性患者（38．5％），差异均有统计学意义（P〈0．05）；MTB阳性患者3月末痰菌阴转率（91．7％）分别略高于MTB＋MTB-L阳性患者（73．7％）及MTB-L阳性患者（76．9％），但差异均无统计学意义（P〉O．05）；MTB＋MTB-L阳性患者2、3月末痰菌阴转率与MTB-L阳性患者比较差异均无统计学意义（尸〉0．05）。结论MTB-L感染可能是结核病患者痰菌阴转率低的重要原因．加强MTB-L感染监测是当前结核病防控的重要策略之一．

Effect of Mycobacterium tuberculosis L form infection on the sputum negative conversionrate in tuberculosis patients

AObjective To analyze the iniection status of Mycobacterium tuberculosis （MTB） and Mycobacterium tuberculosis L form （MTB-L） of tuberculosis patients in Luohu district of Shenzhen; to investigate the effect of MTB-L infection on the sputum negative conversion rate intuberculosis patients. Methods The sputum from 960 cases of definite tuberculosis patients （916 cases of initial treatment and 44 cases of retreatment） in Luohu district from 2010 to 2011 were detected by acid-fast staining method and the positive detection rates of MTB and MTB-L were analyzed. The sputum negative conversion rates of smear-positive tuberculosis patients at the end of 2 and 3 months were calculated respectively; the statistical difference of the sputum negative conversion rates among MTB positive, MTB ＋MTB-L positive and MTB-L positive patients were analyzed. Results Among the 916 cases of initial treatment patients, cases of MTB positive patients were 411, case of MTB＋MTB-L positive patients were 130, case of MTB-L positive patients were 129. In the initial treatment, the sputum negative conversion rates of MTB positive patients at the end of 2 and 3 months （90.3%, 99.5%） were higher than those of MTB＋MTB-L positive （46.9%, 89.2%） or MTB-L positive （45.7%, 89.1%） patients （P〈0.05）; however, no statistical difference was found between the sputum negative conversion rates of MTB＋MTB-L positive patients at the end of 2 and 3 months and those of MTB-L positive patients （P〉0.05）. Among the 44 case of retreatment patients, cases of MTB positive patients were 12, cases of MTB＋MTB-L positive patients were 19, cases of MTB-L positive patients were 13. In the retreatment patients, the sputum negative conversion rates of MTB positive patients at the end of 2 months （83.3%） were higher than those of MTB＋MTB-L positive （42.1%） or MTB-L positive （38.5%） patients （P〈0.05）; however, the sputum negative conversion rates of MTB positive patients at the end of 3months （91.7%） were slightly higher than those of MTB＋MTB-L positive （73.7%） or MTB-L positive （76.9%） patients without statistical difference （P〉0.05）; meanwhile, there was no statistical difference between the sputum negative conversion rates of MTB＋MTB-L positive patients at the end of 2 and 3 months and those of MTB-L positive patients （P〉 0.05）. Conclusion MTB-L infection might be involved in low sputum negative conversion rate in tuberculosis patients. MTB-L infection monitoring is an important strategy of current tuberculosis control.