626例耐药肺结核临床特征及其耐药基因突变分布  

Clinical characteristics of 626 cases of drug-resistant pulmonary tuberculosis and mutations of drug resistance genes

作　　者：方珂 李丹 汤中文 余娇 程芳 FANG Ke;LI Dan;TANG Zhong-wen;YU Jiao;CHENG Fang(Wuhan Jinyintan Hospital,Wuhan,Hubei 430000,China)

机构地区：[1]武汉市金银潭医院手术室,湖北武汉430000 [2]武汉市金银潭医院麻醉科,湖北武汉430000 [3]武汉市金银潭医院结核外科,湖北武汉430000 [4]武汉市金银潭医院护理部,湖北武汉430000

出　　处：《中华医院感染学杂志》2024年第8期1130-1133,共4页Chinese Journal of Nosocomiology

基　　金：湖北省科研基金资助项目(2021FH024010)。

摘　　要：目的分析626例耐药肺结核患者的临床特征及其耐药基因突变特征。方法纳入2018年6月-2022年12月武汉市金银潭医院收治的肺结核患者626例进行研究,根据其结核分枝杆菌耐药情况,分别纳入耐药组(189例)、非耐药组(437例)。分析肺结核患者耐药情况,分析肺结核患者耐药临床特征,分析肺结核患者耐药基因突变特征。结果626例肺结核患者分离626株结核分枝杆菌,其中耐药189例,耐药率为30.19%,耐多药87例,异烟肼、链霉素、利福平耐药率较高;临床特征分析结果显示,耐药组年龄、病历类型复治高于非耐药组(P<0.05);肺结核患者耐药基因突变主要为katG基因突变(315位Ser替代为Thr,突变率为38.10%),rpoB基因突变(521位Ser替代为Leu,突变率为28.04%),rpsL基因突变(43位Lys替代为Arg,突变率为26.98%)。结论肺结核患者耐药情况不容乐观,耐药临床特征包括年龄≥60岁、病历类型复治等,分析其临床特征及耐药基因突变特征,可为预防措施的制定提供依据。OBJECTIVE To analyze the clinical characteristics and mutation of drug-resistant genes in 626 patients with pulmonary tuberculosis.METHODS A total of 626 patients with tuberculosis admitted to Jinyintan Hospital in Wuhan from Jun 2018 to Dec 2022 were included in the study.According to the drug resistance of Mycobacteri-um tuberculosis,the patients were divided into the drug-resistant group(189 cases)and non-drug-resistant group(437 cases).The status of drug resistance,clinical characteristics and the mutation characteristics of drug-resist-ant genes in patients with tuberculosis were analyzed.RESULTS 626 strains of M.tuberculosis were isolated from 626 patients with pulmonary tuberculosis,of which 189 were drug-resistant,with the drug-resistant rate of 30.19%,and 87 were multidrug resistant.Clinical characteristics analysis showed that the age and the rate of re-treatment in the drug-resistant group and the type of retreatment were higher than those in the non-drug-resistant group(P<0.05).The main mutation of drug resistance genes in tuberculosis patients were katG gene mutation(315 Ser replaced by Thr,mutation rate 38.10%),rpoB gene mutation(521 Ser replaced by Leu,mutation rate 28.04%),and rpsL gene mutation(43 Lys replaced by Arg,mutation rate 26.98%).CONCLUSION The drug re-sistance of M.tuberculosis in tuberculosis patients is not optimistic.The clinical characteristics of drug resistance include age≥60 years old and retreatment of medical history type.Analysis of the clinical characteristics and mu-tation characteristics of drug resistance genes could provide a basis for the formulation of preventive measures.

关 键 词：肺结核 耐药 结核分枝杆菌 基因突变 临床特征 

分 类 号：R521[医药卫生—内科学]