复发与治疗失败患者结核分枝杆菌基因型分析

Genotypes of Mycobacterium tuberculosis from the TB Patients With Recurrence or Treatment Failure

目的分析复发和治疗失败患者结核杆菌基因型并进行病原学探讨。方法以2000年1月～2007年12月在北京市结核病胸部肿瘤研究所2次住院相邻时间间隔至少在6个月以上、有分离菌株的肺结核病患者作为研究对象。应用结核分枝杆菌基因分型方法对患者初次和第2次治疗的菌株进行分型并比较。结果24例结核病患者入选本研究。在完成初次治疗的5人中，其前后分离株的基因型均相同；在另19例患者（8例丢失、11例治疗失败）中，有2例（10．5％）患者其分离株的基因型与第1次不同；其余17例（89．5％）患者前后2次分离株的基因型相同。结论内源发病是复发的主要原因，失败和丢失病例中少数存在再感染情况。

Objective To analyze the genotypes of Mycobacterium tuberculosis from the TB patients with recurrence or treatment failure. Methods Tuberculosis （TB） inpatients who had strains isolated from two successive episodes separated for at least 6 months were selected from Beijing Tuberculosis ＆ Thoracic Tumor Institute during January 2000 to December 2007. The sequential isolates from the patients were analyzed by M. tuberculosis genotyping methods to find out if the profiles matched. Results 24 patients recruited into the study. The genotype patterns of recurrent M. tuberculosis isolates from the 5 patients previously completed treatment exhibited identical genotypes, indicating endogenous reactivation. Of 19 isolates from 8 patients defaulted from treatment and 11 patients with treatment failure , genotype patterns of 2 isolates （10.5%） did not match with those of the corresponding initial isolates , indicating reinfection. Isolates from the remaining 17 （89.5 %） patients had identical genotype profiles results, suggesting treatment failure. Conclusions The endogenous reactivation and treatment failure may be a main cause for the recurrence of TB cases.