耐多药结核病患者外周血中多药耐药相关跨膜转运蛋白的表达

Expression of P-glycoprotein and multidrug resistance-associated protein in peripheral blood mononuclear cells from multidrug resistant tuberculosis patients

目的 评价耐多药结核病（MDR-TB）患者外周血中单核细胞P糖蛋白和多药耐药相关蛋白（MRP）表达水平的变化.方法选择2004年9月至2007年12月在武汉市结核病防治所住院治疗的MDR-TB患者89例为耐多药组,其中男52例,女37例;年龄17~62岁,平均（45±6）岁;平均病史3.5年;均符合MDR-TB的诊断标准.同期在武汉市结核病防治所住院的初治结核病患者55例为结核病组,其中男34例,女21例;年龄18~60岁,平均（48±8）岁;平均病史1.2年;痰涂片均为阳性.对照组为武汉市结核病防治所无肺结核史的工作人员31例,其中男19例,女12例;年龄25~62岁,平均（44±5）岁.抽取外周血,采用实时定量PCR法,分别检测单核细胞P糖蛋白和MRP的mRNA水平.多组间比较采用单因素方差分析,组间两两比较采用SNK-q检验.结果 耐多药组P糖蛋白mRNA表达的吸光度值（1.34±0.32）与结核病组（1.12±0.23）和对照组（1.05±0.16）比较,差异无统计学意义（F=0.536,P〉0.05）.耐多药组MRP的mRNA表达（3.45±0.43）明显高于结核病组（1.23±0.34）和对照组（1.04±0.12）,3组比较,差异有统计学意义（F=24.241,P〈0.05）,耐多药组分别与其他2组比较,差异均有统计学意义（P〈0.01）.结论 MRP高表达与MDR-TB患者的多耐药存在一定的相关性.

Objective To evaluate the expression of P-glycoprotein （P-pg） and multidrug resistance-associated protein （MRP） mRNA levels in peripheral blood mononuclear cells from multidrug resistant tuberculosis （MDR-TB） patients. Methods The subjects of this study included 3 groups： a non-TB control group, a TB control group and a MDR-TB group. The 31 subjects in the non-TB control group were staff from Wuhan Tuberculosis Prevention and Treatment Institute. The 55 cases in the TB control group were in-patients during September 2004 to December 2007 who were diagnosed as having pulmonary tuberculosis. The 89 cases in the MDR-TB group were in-patients during the same period, but who were diagnosed as having MDR-TB. Peripheral mononuclear cells were isolated and mRNA levels of P-pg and MRP were measured by real-time PCR. Comparisons of the data between different groups were performed using one-way ANOVA, and SNK q was used for comparison between 2 groups.Results There was no significant difference in the relative P-pg mRNA levels among the MDR-TB group （1.34±0.32）, the non-TB control group （1.05±0.16） and the TB control group （1.12±0.23）, F=0.536, P〉0.05. The relative MRP mRNA level （3.45±0.43） was the highest in the MDR-TB group （3.45±0.43）, as compared to the TB control group （1.23±0.34） and the non-TB control group （1.04±0.12）, F=24.241, P〈0.05. Conclusion Higher expression of MRP in peripheral mononuclear cells might be related to multidrug resistance in MDR-TB patients.