肺結核桿菌之暴露評估 1.醫院空氣中之肺結核桿菌濃度 2.病人呼吸及咳嗽之肺結核桿菌濃度

The exposure assessment of Mycobacterium tuberculosis 1.The concentration of Airborne Mycobacterium tuberculosis Profile in a hospital 2. The Mycobacterium tuberculosis concentration of the patients breath and cough

陳岱煒(Tai-Wei Chen)

指導教授 ： 陳培詩

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2007年)

摘要

目的：本研究旨在應用filter/real-time qPCR了解肺結核桿菌(Mycobacterium tuberculosis；M.ｔ)在醫院之院內感染區域、高風險區域、低風險區域之分佈情形，並探討結核病人其呼吸及咳嗽時所排放出肺結核桿菌之濃度高低情形。
方法：針對院內感染區域：胸腔科與感染科病房、高風險區域：負壓隔離病房、胸腔科與感染科診間與候診區，以及低風險之眼科病房、小兒科所屬診間、候診區進行空氣採樣，在負壓隔離病房進行病人呼出氣體及咳嗽飛沫之採樣，進行DNA萃取後，並以real-time qPCR進行定量分析。
結果：醫院空氣中肺結核桿菌陽性率為6.25%，皆屬於院內感染區域之胸腔及感染科病房，濃度範圍為54~1109 copies/m3，最大濃度出現在胸腔科之護理站。胸腔科護理站空調改善後，則無偵測到肺結核菌，且其細菌濃度也顯著降低（p＝0.010）。空氣中肺結核桿菌存在處，細菌濃度會較高。在空氣中可培養細菌濃度部分，共有122個樣品細菌濃度超過環保署公告之室內空氣品質建議值草案的建議值，不合格率為64％，而真菌之不合格率為8％。胸腔科護理站細菌濃度在空調改善前後皆不符合環保署公告之室內空氣品質建議值。在呼出氣體及咳嗽飛沫部份，病人咳嗽樣品之陽性率為43％(12/28)，呼吸樣品之陽性率為21.5％(6/28)，以目前的結果來看，咳嗽樣品測試方法的敏感度較佳，且病人之痰液培養及抗酸性鏡檢之結果若皆呈現陰性時，本研究之結果皆呈現陰性，代表本研究的特異性良好。
結論：本研究以filter/real-time qPCR方法證實院內感染區域的空氣中有存在結核菌，在醫院的看診區域則沒有測量出結核菌的存在。在呼出氣體及咳嗽飛沫的部份，發現應用filter/real-time qPCR的亦可偵測出結核桿菌的濃度，且病人咳嗽敏感度較呼吸高，病人的接受度也較高。

關鍵字

肺結核桿菌 ； 院內感染 ； 呼出氣體 ； 即時定量聚合酵素反應

並列摘要

Aim: This research is for the purpose of applying filter/real-time the qPCR to understand the distribution of Mycobacterium tuberculosis in the infective area, the high risk area, the low risk area in the hospital, and discuss tuberculosis patient its breath and cough discharges concentration of the Mycobacterium tuberculosis.

Method: To be aimed at the outbreak area : Chest cavity branch and infection branch hospital ward, the high risk area : the negative pressure isolation ward, the chest cavity branch and the infection branch examine with waits to see the doctor the area, as well as ophthalmology department of hospital ward, pediatrics the low risk respectively examine, waits to see the doctor the area to carry on the air sampling, carries on the patient who in the negative pressure isolation ward to exhale the gas and the cough priming sampling of, after carries on the DNA extract, and carries on the quantitative analysis by real-time qPCR.

Result: In the hospital air the Mycobacterium tuberculosis masculine positive rate is 6.25%, all belongs to in the courtyard to infect chest cavity of and the infection branch hospital ward the region, the concentration range is 54~1109 copies/m3, the greatest concentration appears in the nursing station of the chest cavity branch. After the nursing station of the chest cavity branch air conditioning improvement, then not detects the Mycobacterium tuberculosis, also it’s bacterium concentration also reveals is reducing (p = 0.010). In the air the Mycobacterium tuberculosis existence place, the bacterium density can be higher. May the culture of bacteria density be partial in the air, altogether has 122 samples bacteria concentration to surpass room of in the environmental protection bureau announcement the air quality suggestion value draft suggestion value, the failure rate is 64%, but the fungus the failure rate is 8%. The nursing station of the chest cavity branch bacterium concentration around all not to conform to room of in the environmental protection bureau announcement in the air conditioning improvement the air quality suggestion value. In exhales the gas and the cough priming part, the patient coughs masculine positive rate of the sample is 43% (12,/28), masculine positive rate of the breath sample is 21.5% (6,/28), looked by the present result, cough sample test method sensitivity better, also phlegm of fluid raise and the acid resisting mirror the patient examine finally if all presents time the negative, result of the this research all presents the negative, represents this research the specificity to be good.

Conclusion: This research by filter/real-time the qPCR method confirmed in the outbreak area in the air that have the existence Mycobacterium tuberculosis, in the hospital looked examines the region not to survey the Mycobacterium tuberculosis of existence. Is exhaling the gas and the cough priming part, discovered also may detect the bacillus tuberculosis using filter/real-time qPCR the density, also the patient coughs the sensitivity comparatively to breathe high, the patient accepts to be also higher.

並列關鍵字

M. tuberculosis ； nosocomial outbreak ； exhaled gas ； real time qPCR

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