延安市结核分枝杆菌耐药性与耐药基因检测结果分析  

Test results analysis of drug resistance and drug resistance gene for tuberculosis in Yan'an city

作　　者：阳央 侯欢 王东 李慧[3] 冯智 李芳芹[3] YANG Yang;HOU Huan;WANG Dong;LI Hui;FENG Zhi;LI Fangqin(Medical College of Yan'an University,Yan'an,Shaanxi 716000,China;Department of Clinical Laboratory,the Second People's Hospital of Yan'an City,Yan'an,Shaanxi 716000,China;Department of Clinical Laboratory,Affiliated Hospital of Yan'an University,Yan'an,Shaanxi 716000,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]陕西省延安市第二人民医院检验科,陕西延安716000 [3]延安大学附属医院检验科,陕西延安716000

出　　处：《检验医学与临床》2020年第22期3263-3266,共4页Laboratory Medicine and Clinic

基　　金：延安市科技重点研发项目(SL2019ZCSY-103)。

摘　　要：目的探讨延安市结核分枝杆菌耐药性及相关耐药基因突变特征,为临床治疗及结核防控提供参考。方法将延安市第二人民医院2018年1月至2019年8月住院的肺结核患者共302例纳入研究,采用微孔板最低抑菌浓度(MIC)法对一线及部分二线抗结核药物进行药敏试验,同时应用荧光PCR熔解曲线法对利福平(RIF)及异烟肼(INH)表型耐药菌株进行耐药基因突变检测。结果302例患者中男性181例,女性121例,男女比为1.49∶1,总体耐药率为24.5%(74/302),单耐药率为13.6%,多耐药率为5.0%,耐多药率为6.0%,且男性耐药率高于女性(28.7%vs.18.2%,P=0.037);一线药物耐药率:INH(17.2%)>链霉素(SM)(11.3%)>RIF(7.6%)>乙胺丁醇(EMB)(1.3%),二线药物耐药率均较低;耐药模式主要以INH耐药但RIF敏感结核(INHR-TB)为主,占46.0%(34/74),耐多药以耐SM+RIF+INH模式常见,占66.7%(12/18)。RIF耐药菌株中87.0%存在rpoB基因突变,Kat G315和inhA突变介导了88.5%的INH耐药。结论该地区以药物敏感结核和INHR-TB为主,INH耐药和耐多药结核的出现应引起重视,进行耐药基因突变的快速检测有助于结核的治疗和防控。Objective To explore the mutational characteristics of drug resistance and related drug resistance genes of tuberculosis(TB)in Yan'an,and to provide reference for clinical treatment and TB prevention and control.Methods Patients with pulmonary TB hospitalized in the Second People's Hospital of Yan'an City from January 2018 to August 2019 were enrolled in the study,microporous plate MIC method was used to test the drug susceptibility of first-and some second-line anti-TB drugs.At the same time,the mutation of rifampicin(RIF)and isoniazid(INH)phenotypic resistant strains was detected by fluorescence PCR melting curve method.Results Of the 302 patients,181 were male and 121 were female,with a male-to-female ratio of 1.49∶1,the overall drug resistance TB rate was 24.5%(74/302),the overall mono-drug resistance TB rate was 13.6%,the overall poly-drug resistance TB rate was 5.0%,the overall multi-drug resistance TB rate was 6.0%,and the incidence of any drug resistance in men is significantly higher than that in women(28.7%vs.18.2%,P=0.037).First-line drug resistance rate INH(17.2%)>SM(11.3%)>RIF(7.6%)>EMB(1.3%),second-line drug resistance was lower;The main resistant mode was isoniazid resistance,rifampicin-sensitive pulmonary TB(INHR-TB),accounting for 46.0%(34/74),the major multi-drug resistance mode was SM+RIF+INH drug resistance mode,accounting for 66.7%(12/18).87.0% of rifampicin-resistant strains had rpoB gene mutations,and Kat G315 and inhA mutations mediated 88.5% INA resistance.Conclusion Sensitive TB and INHR-TB are the main types in this area,the emergence of INA resistance and multi-drug resistant TB should be paid attention to.Rapid detection of drug-resistant mutations by using the fusion curve method will be helpful in the prevention and treatment of TB.

关 键 词：结核分枝杆菌 耐药性 耐药模式 熔解曲线法 耐药突变 

分 类 号：R446.5[医药卫生—诊断学]