绵阳市结核杆菌耐药性突变检测结果分析

Analysis of drug resistance mutation of Mycobacterium tuberculosis in Mianyang

目的初步分析绵阳市结核杆菌耐药的基因型特征,为制定耐多药结核病治疗方案提供依据。方法应用线性探针法和传统比例法对绵阳市9个县市区分离培养出的586株结核杆菌进行异烟肼和利福平药敏检测;用Kappa一次性检验评价分析两种方法对异烟肼、利福平以及耐多药检测结果的一致性,并根据线性探针检测结果观察结核杆菌耐利福平和异烟肼相关的rpoB、katG、inhA基因的突变情况。结果586株结核杆菌中,Kappa一次性检验评价线性探针技术与传统药敏检测对异烟肼耐药率u系数为0.86,对利福平耐药率u系数为0.86,对耐多药耐药率u系数为0.79。观察线性探针检测结果利福平耐药菌株rpoB的主要突变位点为531、526。异烟肼耐药菌株以katG S315T1突变为主。耐多药菌株利福平和异烟肼的突变以高耐药组合rpoB S531L和katG S531T1为主。结论线性探针检测法能在早期快速准确地检测出耐多药结核患者,同时线性探针的检测结果能帮助临床医生合理地使用利福平和异烟肼,避免高耐药结核患者的出现,但五类高危人群结核患者仍然需要同时做表型药敏检测。

Objective The genotype characteristics of drug resistance of MDR-TB in Mianyang were preliminarily analyzed to provide a basis for the treatment of MDR-TB.Methods The linear probe and the traditional proportional method were applied to detect isoniazid and rifampicin in 586 strains of Mycobacterium tuberculosis isolated from 9 counties and urban areas in Mianyang City,the consistency of two methods in detecting isoniazid,rifampicin and multidrug resistance was evaluated and analysed by the Kappa one-time test,and the mutations of rpoB,katG and inhA genes associated with rifampicin and isoniazid resistance in Mycobacterium tuberculosis were observed according to the result of the linear probe tese.Results Among 586 strains of Mycobacterium tuberculosis,the u-coefficient of the linear probe technology and traditional drug sensitivity test was 0.86 for isoniazid,0.86 for rifampin and 0.79 for multidrug resistance.The results of linear probe showed that the main mutational sites of rpoB of rifampicin resistant strain were 531 and 526.The main mutation of isoniazid resistant strains was katG S315 T1.The mutations of rifampicin and isoniazid resistant strains were mainly the combination of rpoB S531 L and katG S531 T1.Conclusion Linear probe detection can detect MDR-TB patients quickly and accurately,at an early stage.At the same time,the detection results can help clinicians to rationalize the use of rifampicin and isoniazid rationally to avoid patients with highly drug-resistant tubercul-osis patients.However,there are five types of high-risk tuberculosis patients who still need to be tested for phenotypic drug sensitivity.