目的 探讨继发性肺结核合并肺部真菌感染的临床特点及相关高危因素。方法 收集广州市胸科医院2017年7月—2019年10月收治的继发性肺结核患者资料,病程均大于3个月,分为真菌感染组106例和非真菌感染组100例进行回顾性分析。结果 单因素分析结果显示,合并肺部其他疾病、非初治、咯血、空洞、应用广谱抗生素>l周、侵袭性操作存在统计学差异(P<0.05)。Logistic多因素分析结果显示,广谱抗生素使用>l周、侵袭性操作为真菌感染的独立危险因素(P<0.05)。结论 对于应用广谱抗生素、进行侵袭性操作的肺结核患者应警惕真菌感染风险,及早预防及诊治。

Objective To investigate the clinical characteristics and related high risk factors of secondary pulmonary tuberculosis complicated with pulmonary fungal infection. Methods Data of patients with secondary tuberculosis admitted to Guangzhou Chest Hospital from July 2017 to October 2019 were collected. All patients with a course of disease longer than 3 months were divided into the fungal infection group (n =106) and the non-fungal infection group (n =100) for retrospective analysis. Results Univariate analysis results showed that there were statistical differences in combined other pulmonary diseases, non-initial treatment, hemoptysis, cavity, application of broad-spectrum antibiotic > for 1 week, and invasive operation (P<0.05). Logistic multivariate analysis showed that >1 week of broad-spectrum antibiotics and invasive procedures were independent risk factors for fungal infection (P<0.05). Conclusion Patients with tuberculosis who are treated with broad-spectrum antibiotics and invasive procedures should be alert to the risk of fungal infection, early prevention and treatment should be undertaken.

目的 研究鸟胞内分枝杆菌复合群(MAC)MAV3104基因编码蛋白与药物外排的关系。方法 以MAC标准株基因组为模板,扩增MAV3104基因,构建pMV261-MAV3104c重组质粒;测序正确后,转化重组质粒到大肠杆菌DH5并在MAC标准株中诱导表达, Western Blot鉴定MAV3104表达;按照CLSIM24-A2的操作要求检测MAC标准株对克拉霉素的敏感性及外排泵抑制试验。结果 经基因测序及Western Blot蛋白表达验证重组质粒构建成功;MAV3104过表达能提高鸟分枝杆菌对克拉霉素的MIC,且硫利达嗪能抑制该作用;MAV3104过表达也能提高胞内分枝杆菌对克拉霉素的MIC,但硫利达嗪对其没有抑制效应。结论 MAV3104转运蛋白介导的药物外排在鸟分枝杆菌耐克拉霉素中起重要作用。

Objective To investigate the association of the protein coded by Mycobacterium avium-Mycobacterium intracellulare complex in MAV3104 in drug efflux of Clarithromycin. Methods According to the Mycobacterium avium-Mycobacterium intracellulare complex standard strain, the MAV3104 gene was amplified by PCR and cloned into expression vector pMV261 to generate the recombinant plasmids. After verification by sequence analysis, the recombinant plasmids was transformed into E. coli DH5 andMycoba ctenum avium-Mycobacterium intracellulare complex standard strain. To identify the protein expression by western blotting and investigate the sensitivity of clarithromycin and efflux pump inhibition test in the light of CLSIM24-A2 protocol. Results It was verified by sequence analysis and western blotting that the recombinant plasmids were successfully constructed. Over expression of Mycobacterium avium MAV3104 gene could enhance clarithromycin MIC, which could be inhibited by thioridazine. Over expression of Mycobacterium intracellulare MAV3104 gene also could enhance clarithromycin MIC, but it could not inhibited by thioridazine. Conclusion This study demonstrates that efflux pumps mediated by MAV3104 protein play an important role in Mycobacterium avium resistance to clarithromycin.

目的 探讨拉米夫定治疗对乙肝活动的肺结核病人抗结核治疗中的临床价值。方法 通过回顾性分析159例初治肺结核乙肝表面抗原(HBsAg)阳性、HBV-DNA定量阳性病人,所有病例在抗结核前查肝功能均正常,分为两组,治疗组:在抗结核及护肝治疗过程中,加用拉米夫定抗乙肝病毒治疗;对照组:没用任何抗乙肝病毒药物;分别在抗结核治疗前、治疗2周、4周及8周复查肝功能,对比两组间肝损发生率,及肝损发生时间及严重程度。抗结核治疗4周后复查HBV-DNA定量,对比两组间HBV-DNA定量下降例数。结果 治疗组的肝损发生率仅20.5%,对照组病人抗结核治疗后肝损的发生率为53.1%,两者间差异有统计学意义。治疗组肝损出现时间多为大于4周,而且多数是轻度肝损。治疗组出现肝损中断抗结核治疗的病例数低于对照组。抗乙肝病毒治疗后复查HBV-DNA定量降低例数高于对照组。结论 拉米夫定抗乙肝病毒治疗,能抑制乙肝病毒复制,降低乙肝合并肺结核病人的肝损发生率并减轻肝损严重程度,提高病人对抗结核药物的耐受性。