浙江省12个区（县）分枝杆菌菌种鉴定及耐药相关基因特征分析  

Strain identification and analysis of drug resistance gene characteristics in M. tuberculosis strains from 12 districts in Zhejiang Province

作　　者：徐凯进[1] 嵇仲康 胡海洋[1] 毕晟[1] 胡飞枢 郑琳[1] 金秀媛[1] 徐文杰[1] 王淑婷[1] 杨美芳[1] 邵俊丹 李鹏程[1] 黄艳芳[1] 盛吉芳[1] 李兰娟[1] 

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室感染性疾病诊治协同创新中心,杭州310003

出　　处：《中国防痨杂志》2017年第2期154-157,共4页Chinese Journal of Antituberculosis

基　　金：“十二五”国家科技重大专项（2013ZX10004-904;2014ZX10003002）;浙江省卫生和计划生育委员会医药卫生科技计划项目（2015KYA102）

摘　　要：目的了解浙江省12个区（县）分枝杆菌菌种流行情况及结核分枝杆菌的INH、RFP耐药相关基因特征。方法收集2012年1月至2016年6月浙江省12个区（县）初诊为菌阳肺结核患者的2803株临床分离菌株标本，运用基因芯片技术进行菌种鉴定和INH、RFP耐药检测。结果2803份菌株中，NTM占7．3％（205株），前6位菌种为：胞内分枝杆菌101株，堪萨斯分枝杆菌50株，龟-脓肿分枝杆菌24株，鸟分枝杆菌16株，偶然分枝杆菌4株，浅黄色分枝杆菌1株；2598株MTB中耐INH者占12．5％（326株），耐RFP者占9．8％（254株），MDR占6．7％（173株）。425株MTB耐药突变位点结果中，katG315位点占INH耐药突变的81．1％（279／344），rpo531位点占RFP耐药突变的56．6％（155／274）。结论通过涂片诊断肺结核患者中有13．5％（378／2803）为NTM和MDR感染，INH耐药的主要突变位点是katG315，RFP耐药的主要突变位点是rpoB531，在基层医疗机构积极推行分枝杆菌菌种鉴定技术和耐药检测技术将有利于加快我国结核病疫情控制。Objective To analyze the epidemiological characteristics of Mycobacterium strains and drug resistance gene characteristics in Mycobacterium tuberculosis strains from 12 counties in Zhejiang Province, China. Methods From January, 2012, to June, 2016, a total of 2803 sputum positive samples （positive staining that confirmed growth of acid-fast bacilli） were collected from patients newly diagnosed with TB in Zhejiang Province. Mycobacteria Identification Array Kits and M. tuberculosis Drug Resistance Detection Array Kits were used to fur- ther identify and characterize the strains in each sample. Results We identified 2598 of the 2803 strains （92.7 %）, as Mycobacterium tuberculasis and 205 strains （7.3%） as NTM. NTM strains were further identified as follows： Mycobacterium intracellulare , 101 isolates; Mycobacterium kansasii , 50 isolates; Turtle/ Mycobacterium abscessus, 24 isolates; Mycobacterium avium, 16 isolates; Mycobacterium fortuitum, 4 isolates; light yellow Mycobacte- rium,1 isolate. Among the 2598 M. tuberculosis strains there were 326 （12.5%） INH-resistant strains, 254 （9.8%） RFP-resistant strains,and 173 （6.7%） MDR TB strains. Among the drug-resistant strains of M. tubercu- losis, 81.1% （279/344） of the INH-resistant mutations were related to katG315, and 84 （60.0%） of 140 RFP-re- sistant mutations were associated with rpoB531. Conclusion Among the 2803 strains collected from patients in 12 counties of Zhejiang Province, 378 （13.5%） were designated as either MDR TB or NTM. In addition, katG315 was the main point mutation associated with INH resistance in M. tuberculosis strains, and rpoB531 was the main pointmutation for RFP resistance. Mycobacterium strain identification and drug-resistance testing are important in enhan cing regulation and prevention of TB in basic medical institutions.

关 键 词：分枝杆菌  结核 分枝杆菌  非典型性 抗药性  多种 细菌 基因  MDR 点突变 数据 说明  统计 

分 类 号：R378.911[医药卫生—病原生物学]