江西省3个监测点结核分枝杆菌耐药性及耐药基因检测分析

Drug resistance and drug resistance genes of Mycobacterium tuberculosis in three surveillance areas in Jiangxi

目的了解江西省国家级结核病耐药监测点确诊病例的分枝杆菌分离菌株耐药性及耐药基因突变情况,为耐药结核病防治策略制定提供科学依据。方法采用罗氏药敏方法测定结核分枝杆菌的耐药性,并采用PCR-线性杂交酶法进行表型耐药菌株耐药基因检测。结果2019年3个监测点共纳入病例280例。获得264株分离菌株,250株为结核分枝杆菌,14株为非结核分枝杆菌。大余县、进贤县和广丰区3个监测点的分离株总耐药率、单耐药率、多耐药率、耐多药率分别为25.60%(64/250)、7.20%(18/250)、3.20%(8/250)、5.60%(14/250);男性分离株耐药检出率高于女性;S315T1是本地区异烟肼耐药基因突变的主要型别,gyrA基因突变是江西省结核分枝杆菌对氟喹诺酮类药物耐药的主要基因。结论使用PCR-线性杂交酶法筛查一线药、二线药耐药基因突变,对确定治疗方案及结核病的防控有重要意义。江西省要加强对耐药结核病患者的管理,控制传染源,从而减少耐药菌株的产生和传播。

Objective To understand the drug resistance and drug resistance gene mutations of Mycobacterium tuberculosis isolates from three national tuberculosis(TB)drug resistance surveillance areas of Dayu,Jinxian counties and Guangfeng district of Jiangxi province,and provide scientific evidence for the prevention and treatment of drug-resistant tuberculosis.Methods The drug susceptibility of the Mycobacterium tuberculosis in three surveillance areas in Jiangxi was detected by proportional drug sensitivity test and the gene mutations were identified by PCR-linear hybridization enzyme method.Results A total of 280 TB cases from the 3 surveillance areas were included in the study,and 264 strains were isolated,including 250 M.tuberculosis strains and 14 strains of non-tuberculosis mycobacteria.For the M.tuberculosis strains,the overall dugresistance rate was 25.60%(64/250),the mono-drug resistance rate was 7.20%(18/250),the poly-drug resistance rate was 3.20%(8/250),and the rate of MDR was 5.60%(14/250).The detection rate of drug resistance in men was higher than that in women.S315T1 was the main feature of isoniazid resistance gene mutation in this area,and gyrA gene mutation was the main mechanism of M.tuberculosis resistance to fluoroquinolones in Jiangxi.Conclusion The use of PCR-linear hybridization enzyme method to screen first-line drug and second-line drug resistance gene mutations was of great significance for determining treatment options and the prevention and control of TB.It is necessary to strengthen the management of drug resistant TB cases and control the infection sources to reduce the incidence and spread of drug resistant TB in Jiangxi.