结核分支杆菌药敏和耐药基因检测的临床应用和分析

The Clinical Preliminary Application and Analysis for Drug-Sensitive Test and Detecting Drug Resistance Genes to 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和rPSL) ,评估它的临床应用价值。方法 通过Bactec - 960快速培养 ,PCR -SSCP和药物敏感试验了解 114例肺结核病人结核分支杆菌耐药情况 ,分析了临床治疗效果。结果 近 1/ 3的初治肺结核病人至少耐一种抗结核药物 ,RFP、INH和SM敏感株rPOB、katG和rPSL基因突变率分别为 6 5%、11 4 %和 2 7 2 % ,耐药株基因突变率分别为 60 2 %、4 5 7%和 62 7% ,耐药基因突变率随着耐药浓度增高而增高。药敏试验联合耐药基因检测指导治疗效果满意。结论 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 ,可能成为临床指导用药的好方法。

Objective To evaluate the clinic application value of detection of rPOB,katG and rPSL resistance genes to M tuberculosis by polymerase china reaction-single stranded conformation polymorphism (PCR-SSCP).Method The drug-resistance tests of M tuberculosis clinical isolates from 141 patients with the tuberculosis was analyzed by Bactec-960 rapid culture,drug-sensitive and PCR-SSCP techniques.Results As nearly As one of three patients with priliminary treatment had resistance to one kind of the drugs tested at least.The mutation rates of RFP,INH and SM drug-sensitive isolates were 6 5%,11 4% and 27 2% respectively.That of the drug-resistant isolates were 60 2%,45 7% and 62 7%.As drug-resistant concentration heightened,so mutation rate of genes increased.Conclusions Detecting the resistance genes was a new explore in guiding treatment,and multiple drug-sensitive test combinative use have cooperativity each other.It might become good test for clinical management.