2020—2023年宁夏地区结核分枝杆菌利福平耐药性及基因型分析  

Drug resistance of Rifumpicin and genotype analysis of Mycobacterium tuberculosis in Ningxia,2020-2023

作　　者：吕菊芬 刘广天 温静[1,2] 魏建华 LV Ju-fen;LIU Guang-tian;WEN Jing;WEI Jian-hua(School of Public Health,Ningxia Medical University,Yinchuan,Ningxia 750004,China;不详)

机构地区：[1]宁夏医科大学公共卫生学院,宁夏银川750004 [2]宁夏回族自治区环境因素与慢性病控制重点实验室 [3]宁夏回族自治区第四人民医院

出　　处：《现代预防医学》2024年第24期4555-4560,4579,共7页Modern Preventive Medicine

基　　金：宁夏自然科学基金项目(2024AAC05094)、自治区卫健委科研项目(2022NWKY023)。

摘　　要：目的研究2020—2023年宁夏地区结核分枝杆菌利福平耐药性、基因型特征及聚类情况。方法采用GeneXpert MTB/RIF法对98株结核分枝杆菌进行利福平耐药检测,McSpoligotyping方法对菌株进行基因分型并在MIRU-VNTRplus网站进行聚类分析。结果复治患者发展为利福平耐药肺结核的风险显著增加(OR=33.22,95%CI:3.11~355.43,P<0.05),来自中卫市和吴忠市的肺结核患者表现出较高的利福平耐药风险(OR=19.42,95%CI:1.12~336.75,P<0.05;OR=43.25,95%CI:1.76~1062.70,P<0.05)。98株结核分枝杆菌经McSpoligotyping分型呈现出3种家系,最大的家系为北京型80株(81.63%);非北京型占18株(18.37%),其中T型12株(12.24%),U型1株(1.02%),新发现或未定义基因型5株(5.10%)。北京型广泛分布于宁夏各市,固原市与石嘴山市仅为北京型,T型与新发现或未定义基因型多见于中卫市、吴忠市、银川市。聚类分析显示98株菌株分为北京型、非北京型两个基因聚类,成簇的北京型中SIT1占比最大(75.51%),非北京型中T1型最多,其余9株(9.18%)为独立的散在基因型,成簇率为90.82%(89/98)。结论针对宁夏地区复治患者和高风险地区积极开展健康教育,提高治疗依从性,加强中卫市和吴忠市的结核病筛查及耐药性监测工作。此外,该地区结核分枝杆菌具有基因多态性,北京型SIT 1为主要的流行株,加强该基因的监测,了解其传播模式可有效控制结核病的传播、减缓耐药性发展,最终改善当地公共卫生状况具有重要意义。Objective To study the rifampicin resistance,genotypic characteristics and clustering of Mycobacterium tuberculosis in Ningxia from 2020-2023.Methods 98 strains of Mycobacterium tuberculosis were tested for rifampicin resistance using the GeneXpert MTB/RIF method,and the strains were genotyped by the McSpoligotyping method and analyzed by clustering at the MIRU-VNTRplus website.Results The risk of developing rifampicin-resistant TB was significantly increased in retreatment patients(OR=33.22,95%CI:3.11-355.43,P<0.05),and TB patients from Zhongwei and Wuzhong cities showed a higher risk of rifampicin resistance(OR=19.42,95%CI:1.12-336.75,P<0.05;OR=43.25,95%CI:1.76-1062.70,P<0.05).98 strains of Mycobacterium tuberculosis were typed by McSpoligotyping to present three lineages,with the largest lineage being the Beijing-type 80 strains(81.63%);the non-Beijing-type accounted for 18 strains(18.37%),of which 12 strains were of the T-type(12.24%),1 strain of the U-type(1.02%),and the newly 5 strains(5.10%)were newly discovered or undefined genotypes.The Beijing type was widely distributed in all cities of Ningxia,with only the Beijing type in Guyuan and Shizuishan,and the T-type and newly discovered or undefined genotypes were mostly found in Zhongwei,Wuzhong and Yinchuan.Cluster analysis showed that the 98 strains were divided into two genetic clusters,Beijing-type and non-Beijing-type,with SIT1 accounting for the largest proportion of Beijing-type in the clusters(75.51%),T1-type in the non-Beijing-type,and the remaining 9 strains(9.18%)were independent scattered genotypes,with a cluster rate of 90.82%(89/98).Conclusion Health education has been actively carried out for retreatment patients and high-risk areas in the Ningxia region to improve treatment adherence,and TB screening and drug resistance surveillance has been strengthened in Zhongwei and Wuzhong cities.In addition,Mycobacterium tuberculosis is genetically polymorphic in this region,and Beijing SIT 1 is the main prevalent strain.Strengthening the monitoring of

关 键 词：结核病 结核分枝杆菌 利福平耐药 基因分型技术 分子流行病学 

分 类 号：R521[医药卫生—内科学]