南宁地区结核分枝杆菌耐多药表型耐药与基因分子特征的关系研究分析  

Study and analysis of the correlations among multidrug-resistant phenotypic resistance of Mycobacterium tuberculosis and gene molecular characterization in Nanning area

作　　者：玉海玲[1] 梁超娟[1] 奚少勇 磨立达 YU Hai-ling;LIANG Chao-juan;XI Shao-yong(Department of Clinical Laboratory,The Fourth People's Hospital of Nanning City,Guangxi AIDS Treatment Center(Nanning),Nanning Guangxi 530012,China)

机构地区：[1]广西南宁市第四人民医院检验科/广西艾滋病治疗中心(南宁),广西南宁530012

出　　处：《临床和实验医学杂志》2024年第23期2561-2565,共5页Journal of Clinical and Experimental Medicine

基　　金：广西壮族自治区卫生健康委员会科研项目(编号:Z20211331);广西壮族自治区卫生健康委员会科研项目(编号:Z-A20231212)。

摘　　要：目的探究南宁地区结核分枝杆菌(MTB)耐多药表型耐药与基因分子特征的关系,为临床耐药结核病患者的抗结核治疗提供参考。方法选取2021年3月至2023年7月南宁市第四人民医院收治的300例结核病患者作为研究对象,采集患者的痰液、支气管灌洗液、病理材料或切口分泌物等样本进行菌株培养、体外药物敏感试验,选取同时对利福平和异烟肼表型耐药菌株,或还含有耐氟喹诺酮类药物菌株200株,采用荧光定量聚合酶链式反应(PCR)熔解曲线法进行耐多样基因分子检测,分析菌株的相关基因分子特征。结果300例患者中,男性占比75.67%,女性占比24.33%;45岁以上的患者占比56.67%;南宁本地户籍占比83.33%;农村人口占比69.00%;复治类型的治疗占比47.67%。在患者的性别(男、女)、年龄(<30、30~45、>45岁)、户籍(本地、外地)以及地区(农村、城镇)之间的比较中,差异均有统计学意义(P<0.05);在初治和复治的比例上,差异无统计学意义(P>0.05)。200例耐多药结核(MDR-TB)菌株表型耐药情况有2种组合,主要是以耐异烟肼+利福平组合为主,比例为53.50%,其次为异烟肼+利福平+喹诺酮类组合,比例为46.50%;与异烟肼表型耐药的相关基因突变率为89.50%,基因突变类型分别为katG315密码子(61.00%),inhA启动子区(-17~-8位点)+katG315密码子(10.00%),ahpC启动子区(-44~-30以及-15~3位点)(9.00%),inhA启动子区(-17~-8位点)(8.00%),ahpC启动子区(-44~-30以及-15~3位点)+katG315密码子(1.00%),ahpC启动子区(-44~-30位点)+katG315密码子(0.50%);与利福平表型耐药的相关基因突变率为89.50%,分别为rpoB529~533位点(50.50%),RrpoB521~528位点(15.00%),rpoB513~520位点(12.50%),rpoB513~520+rpoB521~528位点(11.50%),rpoB507~512+rpoB513~520位点(2.50%),rpoB521~528+rpoB513~520位点、rpoB521~528+rpoB529~533位点(1.50%),rpoB507~512位点、rpoB507~512+rpoB521~528位点、rpoB513~520+rpoB529~533位点(0.50%);与喹诺酮类药物表型耐药Objective To investigate the correlations among multidrug-resistant phenotypic resistance of Mycobacterium tuberculosis(MTB)and gene molecular characteristics in Nanning,and to guide consultation for the anti-tuberculosis treatment of clinically drug-resistant tuberculosis patients.Methods Three hundred tuberculosis patients received in the Fourth People's Hospital of Nanning City from during 2021 to July 2023 were picked for the research subjects,and samples of sputum,bronchial lavage fluid,pathological materials or incision secretions were collected for strain culture for in vitro drug sensitivity test,and 200 strains of strains that were resistant to rifampicin and isoniazid at the same time,or also contained fluoroquinolone-resistant strains,were selected.Two hundred strains were selected for in vitro drug sensitivity testing,and 200 strains resistant to both rifampicin and isoniazid,or also containing fluoroquinolone-resistant strains,were analyzed for resistance phenotypes and their related genes and molecular characteristics by using the fluorescence quantitative polymerase chain reaction(PCR)lysis curve method.Results Of the 300 patients,75.67%were male,24.33%were female,56.67%were over 45 years of age,83.33%were of local household registration in Nanning,69.00%were of rural population,and 47.67%were of the relapse type of treatment.In the comparisons between patients'gender(male,female),age(<30,30-45,>45 years old),household registration(local,foreign),and region(rural,urban),the differences were statistically significant(P<0.05);in the proportion of first-time and relapse types of treatment,the differences were not statistically significant(P>0.05);There were two combinations of drug resistance in 200 cases of multidrug-resistant tuberculosis(MDR-TB)strains,mainly isoniazid+rifampicin combination,with a proportion of 53.50%,followed by isoniazid,rifampicin and quinolones combination,with a proportion of 46.50%;the rate of isoniazid-resistant gene mutations was 89.50%,and the types of gene mutations were

关 键 词：结核分枝杆菌 耐多药 表型耐药 基因分子 特征 

分 类 号：R52[医药卫生—内科学]