2017-2020年江西省境外输入性恶性疟原虫的抗药性基因多态性研究  

Polymorphisms in drug resistance genes of Plasmodium falciparum imported into Jiangxi,2017-2020

作　　者：施勇[1] 李健雄[1] 熊英[1] 龚甜[1] 周珺[1] 徐刚[1] 肖芳[1] 刘师文[1] 王晓文[1] Shi Yong;Li Jianxiong;Xiong Ying;Gong Tian;Zhou Jun;Xu Gang;Xiao Fang;Liu Shiwen;Wang Xiaowen(Jiangxi Provincial Center for Disease Control and Prevention,Nanchang 330029,Jiangxi,China)

机构地区：[1]江西省疾病预防控制中心,江西南昌330029

出　　处：《疾病监测》2023年第3期321-325,共5页Disease Surveillance

基　　金：江西省卫生健康委普通科技计划(No.20204839)。

摘　　要：目的了解2017—2020年江西省境外输入性恶性疟原虫的抗药性情况,为临床用药提供技术支撑。方法收集2017—2020年江西省输入性恶性疟病例的血液样本,采用巢式PCR方法,对样本抗药性基因进行扩增并测序。结果共收集到输入性恶性疟病例血液样本85份,均为非洲输入。测序分析得出,恶性疟原虫氯喹抗性转运蛋白基因和多药抗性基因1突变比例较低,为16.67%(14/84)和1.18%(1/85),而二氢叶酸还原酶基因突变比例很高,为96.39%(80/83),未发现Kelch螺旋体蛋白基因的突变。结论近几年江西省境外输入性恶性疟病例均来自非洲,且恶性疟原虫对氯喹的抗药性较低,可以结合临床实验,考虑用氯喹联合其他药物治疗非洲输入恶性疟病例的可能方案;对乙胺嘧啶抗药性较高,未发现青蒿素抗性株,但因为近2年受新型冠状病毒感染疫情影响,样本量少,不能排除江西省无青蒿素抗性株,需继续监测。Objective To understand the prevalence of drug resistance of imported Plasmodium falciparum in Jiangxi province from 2017 to 2020 and provide technical support for clinical drug use.Methods From 2017 to 2020,blood samples were collected from imported falciparum malaria cases in Jiangxi,the drug resistant genes of Plasmodium falciparum were amplified using a nested PCR assay,followed by DNA sequencing,and the sequences were aligned.Results A total of 85 blood samples of imported falciparum malaria cases were collected,all the cases were imported from Africa.The mutation rates of chloroquine resistance transporter gene(pfcrt)and multidrug resistance gene 1(pfmdr1)of Plasmodium falciparum were low(16.67%,14/84 and 1.18%,1/85),the mutation rate of dihydrofolate reductase gene(pfdhfr)was high(96.39%,80/83),and no mutation of kelch spirochete gene(K13)was found by sequencing analysis.Conclusion In recent years,imported cases of falciparum malaria in Jiangxi were all from Africa,and the resistance of Plasmodium falciparum to chloroquine was low.Based on the clinical experiments,the treatment of imported falciparum malaria cases from Africa with chloroquine in combination of other drugs can be considered.The resistance to pyrimidine was high,and no artemisinin resistant strain was found.However,due to the impact of COVID-19 epidemic in recent 2 years,it was impossible to conclude that there was no artemisinin resistant strains in our province based on the small sample size,so it is necessary to continue the surveillance.

关 键 词：恶性疟原虫 抗药性 氯喹联合用药 青蒿素 

分 类 号：R211[医药卫生—中医学] R183.5R531.3