205例肺结核合并HIV感染结核菌耐药性及耐药基因检测

Drug resistance and drug resistance gene analysis for 205 cases of pulmonary tuberculosis with HIV-infected patients

目的调查肺结核(TB)合并HIV感染患者耐药性及耐药基因,为TB合并HIV感染的有效诊治提供参考。方法纳入2018年1月—2020年12月河南省郑州市3270例登记在册的TB和(或)HIV感染患者进行结核病筛查,对患者流行病学、耐药性和耐药基因进行研究。结果TB合并HIV感染发生率为6.27%(205/3270),好发于30岁以下人群,47.80%HIV传播途径为性传播,62.93%接受抗结核治疗时间≤6个月,11.22%存在就医延误,62.93%属于TB初治。TB合并HIV感染患者耐药率45.37%,以异烟肼(15.12%)、利福平(11.22%)、链霉素(8.29%)为主。TB合并HIV感染患者标本共检出耐药菌株103株,rpoB基因突变率57.28%,katG和(或)inhA基因突变率为39.81%。结论河南省郑州市TB合并HIV感染发生风险高,青壮年为高危群体,多数存在抗结核治疗时间短及TB初治情况,结核菌耐药及耐药基因分布与单纯TB患者相似。建议加强对该地区高危群体重点筛查及防控,必要时可参考TB患者耐药谱为其制定抗结核治疗方案。

Objective To investigate the drug resistance and drug resistance genes in human immunodeficiency virus(HIV)-infected patients with pulmonary tuberculosis(TB)in Zhengzhou,Henan province,so as to provide reference for effective diagnosis and treatment of HIV infection complicated with TB.Methods 3270 registered HIV-infected(and)or TB patients in Zhengzhou,Henan province were screened for tuberculosis between January 2018 and December 2020.The epidemiology,drug resistance and drug resistance genes were studied.Results The incidence of HIV infection complicated with TB was 6.27%.Among the HIV-infected patients with TB,the majority patients were under 30 years old,47.80%of the patients were infected with HIV through sexual transmission,62.93%received not longer than 6 months of anti-tuberculosis treatment,11.22%had delayed treatment,and 62.93%were initially treated for TB.The drug resistance rate was 45.37%,and mainly to isoniazid(15.12%),rifampicin(11.22%),and streptomycin(8.29%).A total of 103 drug-resistant strains were detected,and the rpoB gene mutation rate was 57.28%.katG and/or inhA gene mutations,with a mutation rate of 39.81%.Conclusions The risk of HIV infection with TB is high in Zhengzhou,Henan Province.Young adults are high-risk groups.Most of them receive short-term anti-TB treatment and initial treatment of TB.The distribution of drug resistance and drug resistance genes in HIV infected patients with TB is similar to those patients with simple TB.It is recommended to strengthen screening and prevention and control of high-risk groups in this area.If necessary,treatment plans for these groups can be developed based on drug resistance spectrum of TB.