青海地区结核分枝杆菌快速检测及耐药特征研究

Rapid detection and drug resistance characteristics of Mycobacterium tuberculosisin Qinghai

目的探讨青海地区耐药结核分枝杆菌(MTB)的相关基因型特点,为开展耐药结核病快速诊断提供依据。方法选择2011年6月-2012年12月西宁市区、农村和农牧区结核病患者的MTB标本各300份,采用MTB微量最低抑菌浓度(MIC)法对耐药结核病进行快速诊断,同时用传统的罗氏药敏法作为对照,采用测序方法分析耐药MTB在不同人群中的分布率,了解青海地区MTB耐药的基因突变特征,基因突变分布和主要流行突变位点。结果西宁市区与农牧区单一耐药及多耐药MTB耐药率比较,牧区明显高于西宁市区和农村,差异有统计学意义(P<0.05);rpoB、katG、gyrA突变率西宁市区分别为52.83%、52.83%、37.74%,农村分别为70.97%、62.90%、45.16%,牧区分别为92.55%、86.17%、81.91%,牧区的基因突变率与西宁市区、农村比较,差异有统计学意义(P<0.05);利福平最常见的突变位点为drpoB(531)占43.66%,异烟肼最常见的突变位点为katG(315),占61.27%;氧氟沙星最常见的突变位点为gyrA占59.52%。结论对青海地区耐药结核分枝杆菌的耐药特征有了进一步了解,为临床医师治疗结核病合理选药提供了依据。

OBJECTIVE To investigate the related gene type characteristics of drug-resistant Mycobacterium tuber-culosis （M TB） in Qinghai region ,so as to provide basis to carry out rapid diagnosis of drug-resistant tuberculosis . METHODS Patients with tuberculosis in Xining urban ,rural and pastoral areas were chosen as MTB samples for 300 copies during Jun .2011 to Dec .2012 ,and the drug-resistant TB was rapid diagnosis by the use of micro-MTB minimum inhibitory concentration （MIC） method ,while the traditional Roche susceptibility method was chosen as a contrast . The distribution rate in different populations of resistant MTB was analyzed by the method of sequencing .So the genetic mutations characteristics , distribution and predominant mutation prevalent sites of drug-resistant MTB in Qinghai region were understood .RESULTS In Xining urban and rural and pastoral areas ,a comparison about drug resistant rate of single-drug resistant and multi-drug resistant MTB showed that the drug resistant rate in pastoral areas was significantly higher than that in Xining urban and rural areas ,and the difference was significant（P〈 0 .05）.The mutation rates of rpoB katG ,gyrA in Xining city were 52 .83% ,52 .83% , 37 .74% ,respectively ;the mutation rates in rural areas were 70 .97% ,62 .90% ,45 .16% ,respectively ;and the mutation rates in pastoral areas were 92 .55% ,86 .17% ,81 .91% .The gene mutation rate in pastoral areas compared with that in Xining urban and rural areas ,the difference was significance（P〈0 .05） .The most common mutation site of Rifampicin was drpoB （531） ,accounting for 43 .66% ,the most common mutation site of isoniazid was katG （315） ,accounting for 61 .27% ,and the most common mutation site of ofloxacin was gyrA ,accounting for 59 .52% .CONCLUSION This paper helps us have a better understanding of the characteristics of Qinghai drug-resistant M .tuberculosis and provides effective drug information for clinician to treat tuberculosis .