初治和复治肺结核病例中北京基因型结核分枝杆菌与抗结核药物耐药性的关联研究

Study on Correlation between Prevalence of Beijing Genotype Mycobacterium tuberculosis and Anti-tuberculosis Drug Resistance in Initial Treatment and Retreatment of Tuberculosis Patients

目的探讨北京地区初治和复治肺结核病病例中北京基因型结核分枝杆菌(M.tb)流行与抗结核药物耐药性出现的相关性。方法收集北京各区县菌阳M.tb必临床分离株1140例,采用比例法进行药物敏感性检测;应用间隔区寡核苷酸分型方法鉴定北京基因型和非北京基因型:分析基因型流行和耐药性产生间的相关性。结果在初治病例中,北京基因型M.tb中异烟肼(INH)、阿米卡星(AK)、卷曲霉素(CPM)和对氨基水杨酸(PAS)的耐药率均低于非北京基因型(χ^(2)值分别为2.670、15.282、16.219、22.676,Z5值均<0.05)。在复治病例中,北京基因型M.tb必中AK、PAS的耐药率均低于非北京基因型(χ^(2)值分别为15.167、4.574,P值均<0.05);北京基因型M.tb你中耐多药结核病菌株的比例低于非北京基因型(χ^(2)值为7.046,P<0.05)。结论在初治和复治病例中北京基因型M.tb必的流行和抗结核药物耐药性的出现有不同的相关性,在初治病例中和INH、AK、CPM和PAS耐药性的出现有关联,而在复治病例中只在AK和PAS耐药性的产生上有关联,同时在复治病例中北京基因型菌株中出现耐多药结核病的概率更低。

Objective To explore the correlation between the prevalence of Beijing genotype Mycobacterium tuberculosis(M.tb)and the resistance of anti-tuberculosis drugs in the initial treatment and retreatment patients with tuberculosis in Beijing.Methods A total of 1140 cases of Mycobacterium tuberculosis clinical strains from various districts in Beijing were randomly collected.The drug susceptibility test was carried out by proportional method.The Beijing genotype and non-Beijing genotype Mycobacterium tuberculosis were identified by Spoligotyping method.Statistical methods were used to analyze the association between drug resistance and the prevalence of Beijing genotypes.Results Among the tuberculosis patients with initial treatment,the percentages of strains resistant to isoniazide.amikacin,capreomycin.para-aminosalicylic among Beijing genotype family strains were significantly lower than those among non-Beijing genotype strains(χ^(2)=2.670,15.282,16.219,22.676,all P<0.05).Among the retreatment tuberculosis cases,the percentages of strains resistant to amikacin and para-aminosalicylic among Beijing genotype family strains were significantly lower than those among non-Beijing genotype strains(χ^(2)=15.167,4.574,all P<0.05),the percentage of multidrug-resistant tuberculosis among Beijing genotype family strains was significantly lower than that among non-Beijing genotype strains(χ^(2)=7.046,P<0.05).Conclusions There are different associations between the prevalence of Beijing genotypic Mycobacterium tuberculosis and the occurrence of the resistance to antituberculosis drugs in initial treatment and retreatment cases.There are associations with the occurrence of drug resistance to isoniazide,amikacin,capreomycin and para-aminosalicylic in initial treatment cases,while there are associations only with the occurrence of drug resistance to amikacin and para-aminosalicylic in retreatment cases.Meanwhile,the percentage of multidrug-resistant tuberculosis occurred from Beijing genotypic strains is lower in retreatment cases.