结核分支杆菌耐喹诺酮等四种耐药基因检测的临床应用和评价

The clinical application and evaluation on detecting four drug resistance genes in mycobacterium tuberculosis

目的 :采用聚合酶链反应 -单链构象多态性分析 (PCR SSCP)检测结核分支杆菌耐药基因 (rPOB、katG、rPSL和gyrA) ,评估它的临床应用价值。方法 :通过Bactec 960快速培养 ,利用PCR SSCP和药物敏感试验了解 96例肺结核病人结核分支杆菌耐药情况 ,分析临床治疗效果。结果 :利福平、异烟肼、链霉素和喹诺酮类耐药率分别为 5 9 4%、5 2 1%、62 5 %和 5 1 0 %。分离株rPOB、katG、rPSL和gyrA基因突变率分别为 5 7 3 %、45 8%、5 8 3 %和 47 9% ,药敏试验联合耐药基因检测指导治疗效果满意。结论 :结核分支杆菌耐药与基因突变有关 ,耐药基因检测指导治疗是一种新探索 ,与药敏试验联合应用可互相弥补 ,可成为临床指导用药的好方法。

Objective To evaluate detection of Mycobacterium tuberculosis detection rPOB, katG, rPSL and gyrA resistance genes with polymerase chain reaction-single-stranded conformation polymorphism (PCR-SSCP). Methods Analyzed the mutation of genes and results of drug-sensitive test in 96 Mycobacterium tuberculosis clinical isolates with Bactec-960, drug-sensitive test and PCR-SSCP. Clinical treatment effect was evaluated. Results The drug resistance rate of drug-sensitive test were 59.4%, 52.1%, 62.5% and 51.0%, respectively for RFP, INH, SM and quinolones. The genes mutation rate of isolates were 57.3%, 45.8%, 58.3% and 47.9%, respectively. The treatment effect was contented by drug-sensitive test and PCR-SSCP. Conclusion The resistance of mycobacterium tuberculosis was correlative with genes mutation. Detecting the resistance genes is a new explore in guiding treatment, and remede each other with drug-sensitive test. It might become good test for clinical management.