结核分枝杆菌利福平耐药影响因素及rpoB基因突变位点分析  

Influencing factors of rifampicin resistance and analysis of rpoB gene mutation sites in Mycobacterium tuberculosis

作　　者：刘海清[1] 张威 LIU Haiqing;ZHANG Wei(Fuyang Second People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市第二人民医院,安徽阜阳236000

出　　处：《中国热带医学》2024年第1期96-101,共6页China Tropical Medicine

基　　金：阜阳市卫生健康委科研立项课题(No.FY2019-061)。

摘　　要：目的研究结核分枝杆菌利福平耐药的影响因素及rpoB基因的突变频率和分布,分析耐药决定区(RRDR)的突变特征,为耐利福平结核病流行趋势、预防控制和治疗提供可靠的实验室依据。方法选取2019年3月—2021年12月在阜阳市第二人民医院就诊的312例肺结核患者,经Xpert MTB/RIF、液体药敏检测,将156例利福平耐药的肺结核患者作为耐利福平组,156例非耐药的肺结核患者作为普通组,分析两组患者的一般资料及rpoB基因突变情况。结果在312例肺结核患者中,耐利福平组的有合并症、复治患者、自行服药、不规范服药、治疗中断及不了解传染途径显著高于普通组,差异均有统计学意义;经Logistic回归分析,有合并症、复治患者是利福平耐药的危险因素;156例耐利福平标本中,单基因突变有152例(97.44%),双基因突变4例(2.56%),单基因突变最高的是ProbeE,其次是ProbeD;双基因突变依次是D+E、A+B;在初复治组间,ProbeE有统计学意义(χ^(2)=3.97,P<0.05),其他均无统计学意义;耐多药118例突变位点占比最高是ProbeE,其次是ProbeD;单耐利福平38例,突变位点占比从高到低是ProbeE、ProbeD;4例双基因突变均是MDR-TB;MDR-TB与RR-TB之间突变位点差异均无统计学意义。结论对有合并症、复治患者的肺结核病患者应加以关注,应及时干预以降低利福平耐药的概率;耐利福平患者中,rpoB基因突变主要是单探针突变,与耐多药患者的rpoB基因突变位点并无差异。Objective To investigate the influencing factors of rifampicin resistance and the mutation frequency and distribution of rpoB gene in Mycobacterium tuberculosis,and to analyze the mutation characteristics of resistance-determining region(RRDR),so as to provide reliable laboratory evidence for the epidemic trend,prevention,and treatment of rifampicinresistant tuberculosis.Methods A total of 312 patients with pulmonary tuberculosis who were treated in the Second People's Hospital of Fuyang from March 2019 to December 2021 were selected.After Xpert MTB/RIF and liquid drug susceptibility test,156 patients with rifampicin-resistant pulmonary tuberculosis were selected as the rifampicin-resistant group,and 156 patients with non-drug-resistant pulmonary tuberculosis were selected as the general group.The general information and rpoB gene mutation of the two groups of patients were analyzed.Results Among the 312 cases of pulmonary tuberculosis patients,the presence of complications,retreatment,self-medication,non-standard medication,treatment interruption,and low awareness of transmission routes were significantly higher in the rifampicin-resistant group than in the general group,and the differences were all statistically significant;logistic regression analysis showed that comorbidity and retreatment were the risk factors of rifampicin resistance.Among the 156 rifampicin-resistant specimens,152(97.44%)had single-gene mutations and 4(2.56%)had double-gene mutations.The highest single-gene mutation was ProbeE,followed by ProbeD;the double-gene mutations were D+E,followed by A+B;statistically significant differences were observed for ProbeE between the initial treatment and retreatment groups(χ^(2)=3.97,P<0.05),while others showed no statistically significant differences;among 118 multidrug resistance mutations,ProbeE accounted for the highest proportion,followed by ProbeD;there were 38 cases of single rifampicin resistance,and the proportion of mutation sites from high to low was ProbeE and ProbeD;all 4 cases of double-g

关 键 词：结核分枝杆菌 利福平 基因 突变 

分 类 号：R52[医药卫生—内科学]