重庆地区梅毒螺旋体基因分型及其临床相关性研究

Genetype of Treponema pallidum and its clinical correlation in Chongqing

目的:调查重庆地区梅毒螺旋体基因亚型的分布,初步探讨基因亚型与临床相关性。方法:收集2010年6月至2013年10月重庆地区421例梅毒标本,用巢式PCR检测梅毒螺旋体DNA多聚酶I基因(DNA polymerase I gene,pol A),然后扩增阳性标本酸性重复蛋白基因(acid repeat protein,arp)和苍白密螺旋体重复家族基因(treponema pallidum repeat,tpr)及TP0548基因,分别根据Pillay标准基因分型和三基因分型法进行分型,利用双侧Fisher’s exact test进行数据统计分析,初步探讨不同基因亚型与血清固定、梅毒复发和吉海反应的相关性。结果:163例标本pol A PCR检测阳性,arp、tpr基因和TP0548基因亚型分别以14型、d型和f型为主。正规驱梅治疗12月后,32例患者血清固定,其中tpr基因d型(11例)、a和b型(各2例)和f型(1例);3例患者梅毒复发,其中TP0548基因c型(2例)和f型(1例);8例发生吉海反应,其中14f/f(4例),14d/f(3例)和未分型(1例)。结论:重庆地区梅毒螺旋体以14、d和f型为优势型。梅毒血清固定可能与tpr基因b型相关,14f/f基因型的二期梅毒患者易发生苄星青霉素治疗后的吉海反应。

Objective：To investigate the distribution of the subtype of Treponema pallidum（TP）in Chongqing,and to explore the clinical correlation of genetype. Methods：Four hundred twenty one specimens were collected from patients with seropositive syphilis from June 2010 to October 2013,and were screened by nested PCR targeted TP DNA polymerase I gene（pol A）. The acid repeat protein（arp）,treponema pallidum repeat（tpr）and TP0548 genes were amplified with the positive specimens above. Then the strains were subtyped according to Pillay＇s criteria and subtyping method of targeted three genes. Analysis was made concerning the correlation of different genetypes with sero-resistance,syphilis recurrence and Jarisch-Herxheimer reaction by Fisher＇s exact test,respectively. Results：Totally 163 specimens were positive by PCR targeted pol A gene. Of 116 TP positive specimens subtyped by arp,subtype 14 was the predominate genotype,while of 114 specimens subtyped by tpr gene,d was the most common genotype. Of 117 specimens subtyped by TP0548 gene,subtype f was predominate. At 12 months after standard treatment,32 patients occurred sero-resistance including 11 subtype d,2 subtype b,2 subtype a and 1 subtype f. Three patients experienced syphilis recurrence including2 TP0548 subtype c and 1 subtype f. Eight patients developed Jarisch-Herxheimer reaction,including 4 genotype 14f/f,3 genotype 14d/f and 1 patient failing to subtype. There were statistical differences in the correlation of molecular subtypes with sero-resis-tance and Jarisch-Herxheimer reaction（P=0.000,P=0.029）,while no statistical difference of the correlation of genetypes with syphilis recurrence was found（P=0.333）. Conclusion：The predominate subtypes of TP in Chongqing is subtype 14,d and f. It is suggested that the sero-resistance be related with TP tpr subtype b and the second satge syphilis with 14f/f is more likely to develop a Jarisch-Herxheimer reaction following benzathine penicillin treatment.