福建省龙岩市411例肺结核患者对利福平和异烟肼耐药状况的研究  

Study on resistance to rifampicin and isoniazid in 411 cases of pulmonary tuberculosis in Longyan City,Fujian Province

作　　者：张满娥[1] 黄文滨 卢志华 张洪彬[1] Man-e ZHANG;Wen-bin HUANG;Zhi-hua LU;Hong-bin ZHANG(Department of Molecular Biology Laboratory,the Second Hospital of Longyan,Fujian Province,Longyan 364000,China)

机构地区：[1]福建省龙岩市第二医院分子生物实验室,364000

出　　处：《中国防痨杂志》2020年第1期54-59,共6页Chinese Journal of Antituberculosis

摘　　要：目的回顾性分析福建省龙岩市411例肺结核患者对利福平和异烟肼的耐药状况,为当地结核病防治工作提供科学依据。方法收集2016年5月12日至2019年8月17日福建省龙岩市第二医院门诊及收住入院并确诊为肺结核的411例患者,其中初治患者312例,复治患者99例。作者对两组患者411株结核分枝杆菌临床分离株采用基因芯片技术进行利福平与异烟肼耐药性及其相关耐药基因突变位点的检测。采用Excel 2003和SPSS 20.0软件进行数据的整理和统计学分析,计数资料的比较采用χ^2检验,以P<0.05为差异有统计学意义。结果411例肺结核患者中,初治患者利福平和异烟肼任一位点突变率[9.3%(29/312)]明显低于复治任一位点突变率[54.5%(54/99)](χ^2=95.483,P<0.05);初治患者同时耐利福平和异烟肼的耐药率(简称“耐两药率”)[2.9%(9/312)]明显低于复治耐两药率[33.3%(33/99)](χ^2=75.944,P<0.05)。利福平和异烟肼任一位点突变率为20.2%(83/411),其中利福平耐药基因ropB的突变率为5.4%(22/411),20例为单一位点突变,2例为双位点突变,以531(C→T)突变频率最高[40.9%(9/22)];异烟肼耐药基因katG和inhA的突变率为4.6%(19/411),其中13例为katG基因突变,6例为inhA基因突变,以315(G→C)突变频率最高[63.2%(12/19)];耐两药率为10.2%(42/411),其中40例为双位点突变,1例为三位点突变,1例是四位点突变,以531(C→T)315(G→C)突变频率最高[47.6%(20/42)]。结论龙岩市肺结核耐药患者以耐两药为主,复治患者耐两药的情况较初治患者严重,防治形势严峻。Objective To retrospectively analyze the drug resistance to rifampicin and isoniazid in 411 cases of pulmonary tuberculosis(PTB)in Longyan City,Fujian Province,and provide a scientific basis for the prevention and treatment of tuberculosis in local areas.Methods From May 12,2016 to August 17,2019,411 PTB patients who admitted to the outpatient department and hospitalized in the Second Hospital of Longyan City,Fujian Province were collected,including 312 patients with initial treatment and 99 patients with retreatment.Resistance to rifampicin and isoniazid and the mutation sites of related resistance gene were detected in 411 clinical isolates of Mycobacterium tuberculosis using gene chip technology,and the results were compared between patients with initial treatment and retreatment.Data were collated and statistically analyzed using Excel 2003 and SPSS 20.0 software,respectively.Comparison of count data was performed using theχ^2 test.P<0.05 was considered statistically significant.Results In 411 PTB patients,the mutation rate of rifampicin and isoniazid at any site of patients with initial treatment was significantly lower than that with retreatment(9.3%(29/312)vs 54.5%(54/99),χ^2=95.483,P<0.05);and the multidrug-resistance rate of patients with initial treatment was obviously lower than that with retreatment(2.9%(9/312)vs 33.3%(33/99),χ^2=75.944,P<0.05).The mutation rate of rifampicin and isoniazid at any site was 20.2%(83/411),among which,the mutation rate of rifampicin resistance gene(ropB)was 5.4%(22/411),including 20 cases with single-site mutations and 2 cases with double-site mutations,and the mutation frequency of 531(C→T)was the highest(40.9%(9/22));the mutation rate of isoniazid resistance genes(katG and inhA)was 4.6%(19/411),including 13 cases with katG mutation and 6 cases with inhA mutation,and the mutation frequency of 315(G→C)was the highest(63.2%(12/19));the multidrug-resistance rate was 10.2%(42/411),including 40 cases with double-site mutations,1 case with three-site mutation and 1 case

关 键 词：分枝杆菌 结核 结核 抗多种药物性 异烟肼 利福平 基因 细菌 点突变 小地区分析 

分 类 号：R521[医药卫生—内科学] R446.5[医药卫生—临床医学]