北京基因型结核分枝杆菌的流行及与二线抗结核药物耐药性的相关性  

Study on the prevalence of Beijing genotype Mycobacterium tuberculosis and its relationship with second-line anti-tuberculosis drug resistance

作　　者：梁晨 张旭霞[1] 邢青[2] 易俊莉[2] 张雨晴 李传友[1] 刘毅[1] 唐神结[3] Liang Chen;Zhang Xuxia;Xing Qing;Yi Junli;Zhang Yuqing;Li Chuanyou;Liu Yi;Tang Shenjie(Department of Bacteriology and Immunology,Capital Medical University,Beijing Chest Hospital/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;Central Laboratory,Beijing Research Institute for Tuberculosis Control,Xicheng District,Beijing 100035,China;Department of Tuberculosis,Capital Medical University,Beijing Chest Hospital/Beijing Tuberculosis and Thoracic TumorResearch Institute,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院,北京市结核病胸部肿瘤研究所耐药结核病研究,北京市重点实验室细菌免疫室,101149 [2]北京结核病控制研究所中心实验室,100035 [3]首都医科大学附属北京胸科医院,北京市结核病胸部肿瘤研究所结核病多学科诊疗中心,101149

出　　处：《中华结核和呼吸杂志》2020年第4期356-361,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：首都卫生发展科研专项(首发2018-1-1041);通州两高人才运河计划(YH201804)。

摘　　要：目的探讨北京市北京基因型MTB的流行风险因素及其与二线抗结核药物耐药性的相关性。方法收集北京各区县MTB菌阳临床株1140例,采用比例法进行药敏试验;采用间隔区寡核苷酸分型(Spoligotyping)方法鉴定北京基因型与非北京基因型MTB;使用SPSS 22.0统计学软件,采用χ2检验或Fisher精确概率检验方法对实验数据进行统计学分析。结果在1140株MTB临床分离株中,北京基因型941株(82.5%),非北京基因型199株;北京基因型菌株来源的患者中男性663例(70.5%),非北京基因型菌株来源的患者中男性124例(62.3%),两者比较差异有统计学意义[P=0.021,OR(95%CI):1.442(1.048~1.985)];北京基因型菌株来源的患者中流动人口441例(46.9%),非北京基因型菌株来源的患者中流动人口78例(39.2%),两者比较差异有统计学意义[P=0.048,OR(95%CI):1.368(1.001~1.869)];北京基因型菌株来源的患者中年龄≥65岁的患者129例(13.7%),非北京基因型菌株来源的患者中40例(20.1%),二者比较差异有统计学意义[P=0.021,OR(95%CI):0.631(0.426~0.936)];北京基因型菌株中对左氧氟沙星(Levofloxacin,Lfx)、阿米卡星(Amikacin,Am)、卷曲霉素(Capreomycin,Cm)、对氨基水杨酸(Para-aminosalicylic,PAS)的耐药率分别为5.5%(52/941)、1.3%(12/941)、3.2%(30/941)和3.0%(28/941),非北京基因型菌株对以上4种药物的耐药率分别为10.6%(21/199)、8.5%(17/199)、12.6%(25/199)和11.6%(23/199),二者对4种药物的耐药率比较差异均有统计学意义(均P<0.05);北京基因型菌株中耐多药(MDR)菌株58株(6.2%),非北京基因型菌株中MDR菌株19株(9.5%),两者比较差异无统计学意义(P>0.05)。结论北京基因型MTB在北京广泛流行且在男性人群和流动人口中的比例较高;与非北京基因型菌株相比,北京基因型菌株对Lfx、Am、Cm及PAS的耐药率低,但MDR-TB患者的比例无显著差异。Objective To explore the prevalence risk factors of Beijing genotype Mycobacterium tuberculosis(MTB)in Beijing and its correlation with second-line anti tuberculosis drug resistance.Methods A total of 1140 clinical MTB positive strains were collected from various districts in Beijing,and the drug sensitivity was detected by proportion method.Beijing genotype and non Beijing genotype MTB were identified by the method of Spoligotyping.Using SPSS 22.0 statistical software,chi square test or Fisher exact probability test was used to analyze the experimental data.Results Among 1140 MTB clinical isolates,941(82.5%)were Beijing genotype MTB,199 were non Beijing genotype MTB.There were 663 males(70.5%)in Beijing genotype and 124 males(62.3%)in non Beijing genotype strains.There were significant differences in the proportion of males between the two genotypes[P=0.021,OR(95%CI):1.442(1.048-1.985)].There were 441 floating population(46.9%)in Beijing genotype MTB and 78 floating population(39.2%)in non Beijing genotype MTB.There was a significant difference in the proportion of floating population between the two genotypes[P=0.048,OR(95%CI):1.368(1.001-1.869)].There were 129 patients(13.7%)aged 65 or older in Beijing genotype MTB,40 patients(20.1%)aged 65 or older in non Beijing genotype MTB.The difference was statistically significant[P=0.021,or(95%CI):0.631(0.426-0.936)].The resistance drug rates of Levofloxacin(Lfx),Amikacin(Am),Capreomycin(Cm),Para-aminosalicylic(PAS)in Beijing genotypes were 5.5%(52/941),1.3%(12/941),3.2%(30/941)and 3.0%(28/941),respectively,and those of non Beijing genotypes were 10.6%(21/199),8.5%(17/199),12.6%(25/199)and 11.6%(23/199),the difference was statistically significant(all P<0.05).There were 58(6.2%)multidrug-resistant(MDR)strains in Beijing genotype MTB and 19(9.5%)multidrug-resistant strains in non Beijing genotype.There was no significant difference in the proportion of MDR strains between Beijing genotype and non Beijing genotype(P>0.05).Conclusions Beijing genotype MTB is widespread in

关 键 词：分枝杆菌 结核 抗结核药物 耐药 

分 类 号：R4[医药卫生—临床医学] R5