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目的研究广州地区未经治疗的HIV/AIDS患者合并感染非结核分枝杆菌(NTM)原发表型耐药特征,为HIV/AIDS合并NTM病的临床治疗提供重要依据。方法经hsp65、16S-r DNA、16S-23S-r DNA ITS多基因测序的方法对2008~2013年期间分离自HIV/AIDS患者的147株分枝杆菌进行菌种鉴定,对鉴定为NTM的菌株,采用以罗氏培养基为基础的比例法,对于目前临床应用的一线和二线抗结核药物进行药物敏感性试验。结果 147株HIV/AIDS患者感染分枝杆菌中,鉴定为NTM的57株(38.8%),其中鸟分枝杆菌15株(26.3%),鸟分枝杆菌复合群10株(17.5%),堪萨斯分枝杆菌7株(12.3%)。选取其中未混合感染的38株NTM进行药敏试验,结果显示:NTM对对氨基水杨酸异烟肼(力克肺疾,Pa)耐药率最高,为94.7%,其他依次为阿米卡星(86.8%)、链霉素(84.2%)、异烟肼(81.6%)、左氧氟沙星(68.4%)、克拉霉素(68.4%)、利福平(65.8%)、莫西沙星(39.5%),而对丙硫异烟胺、乙胺丁醇、利福布汀较为敏感,敏感率依次为94.7%、84.2%、76.3%。结论广州地区HIV/AIDS患者合并感染NTM以鸟分枝杆菌和鸟分枝杆菌复合群为主。NTM对常用抗结核药原发耐药率较高,而丙硫异烟胺、乙胺丁醇、利福布汀对NTM有较好的抑菌效果。
Objective To investigate the primary phenotypic drug resistance of non-tuberculosis patients (NTM) in untreated HIV / AIDS patients in Guangzhou, and provide an important basis for clinical treatment of HIV / AIDS complicated with NTM. Methods 147 M. mycobacteria isolated from HIV / AIDS patients during 2008-2013 were identified by sequencing of hsp65, 16S-r DNA and 16S-23S-r DNA ITS gene. The strains identified as NTM , Using the Roche medium-based ratio method for the current clinical application of first-line and second-line anti-TB drugs for drug susceptibility testing. Results 57 out of 147 strains of HIV / AIDS infected with Mycobacterium tuberculosis were identified as NTM (38.8%), of which 15 were Mycobacterium avium (26.3%), 10 were Mycobacterium avium complex (17.5%), Mycobacterium strain 7 (12.3%). Thirty-eight NTMs were selected for susceptibility testing. The results showed that NTM showed the highest resistance rate to isoniazid (Pa), which was 94.7%, followed by amikacin (86.8%), Streptomycin (84.2%), Isoniazid (81.6%), Levofloxacin (68.4%), Clarithromycin (68.4%), Rifampin (65.8% , While sensitive to prothion, ethambutol and rifabutin, the sensitivity rates were 94.7%, 84.2% and 76.3%, respectively. Conclusions The NTM co-infected with HIV / AIDS patients in Guangzhou is mainly composed of Mycobacterium avium and Mycobacterium avium complex. NTM has high rate of primary drug resistance to commonly used anti-TB drugs, and propranolol, ethambutol and rifabutin have good antibacterial activity against NTM.