新疆阿克苏地区结核分枝杆菌的基因分型与耐药性分析

Genotyping and drug resistance analysis of mycobacterium tuberculosis in aksu,xinjiang

目的:对新疆阿克苏地区结核杆菌临床分离株进行可变数目串联重复序列多态性分析(MIRU-VNTR)及耐药性检测,初步了解该地区结核杆菌基因分型及表型耐药状况,分析该地区成簇状况及影响因素。方法:收集2018年9月~2019年10月阿克苏地区痰涂片阳性的维吾尔族结核病患者中分离到的结核分枝杆菌186株,进行12位点MIRU-VNTR基因分型和北京型基因检测,采用比例法对一线抗结核药进行药敏试验,采用BioNumerics7.1软件进行聚类分析,SPSS17.0软件进行数据分析。结果:①该地区总耐药率34.9%,初治耐多药率15.8%,复治耐多药率47.2%;②北京基因型101株,非北京基因型85株。北京型和非北京型二者在耐药性上差异无统计学意义(P>0.05);③共产生156种基因型,其中独特基因型129种,余成27簇,成簇率16.1%。成簇型与独特型在性别、吸烟史、慢阻肺、营养不良史、文化程度、家庭年收入等差异无统计学意义(P>0.05),耐多药和治疗是患者成簇(近期传播)的独立危险因素。结论:阿克苏地区结核杆菌呈现明显的基因多态性;耐多药和复治是患者成簇即近期传播的独立危险因素。

Objective The variable number tandem repeat polymorphism(MIRU-VNTR)and drug resistance of clinical isolates of Mycobacterium tuberculosis in Aksu area of Xinjiang were analyzed.The genotypes and phenotypic drug resistance of Mycobacterium tuberculosis in this area were preliminarily understood,and the clustering status and influencing factors were analyzed.Method 186 strains of Mycobacterium tuberculosis isolated from Uighur tuberculosis patients with sputum smear positive in Aksu area from September 2018 to October 2019 were collected for MIRU-VNTR genotyping at 12 loci and Beijing type gene detection.The first-line anti tuberculosis drugs were tested for drug sensitivity by proportion method,clustering analysis was carried out by using bionumerics 7.1 software,and data analysis was carried out by SPSS17.0 software.Results①The total drug resistance rate in this area was 34.9%,the initial drug resistance rate was 15.8%,and the relapse drug resistance rate was 47.2%;②101 strains of Beijing genotype and 85 strains of non Beijing genotype.There was no significant difference between Beijing type and non Beijing type and drug resistance(P>0.05);③There were 156 genotypes,129 of which were unique genotypes,and the remaining 27 clusters,the clustering rate was 16.1%.There was no significant difference in sex,smoking history,COPD,malnutrition history,education level and family income between the two groups(P>0.05),Independent risk factors for clustering(recent spread)of MDR and treatment history patients.Conclusion In Aksu area,Mycobacterium tuberculosis showed obvious gene polymorphism,and multidrug resistance and retreatment were independent risk factors for clustering or short-term transmission.