高分辨率熔解曲线检测背景下结核分枝杆菌链霉素和乙胺丁醇耐药模式分析

Distribution characteristics of Mycobacterium tuberculosis and streptomycin and ethambutol resistance patterns by high-resolution melt analysis

目的研究洛阳市和县区结核分枝杆菌链霉素与乙胺丁醇耐药模式,指导临床用药,补充当地耐药结核的流行病学数据。方法该研究共纳入2941例高分辨率熔解曲线(HRM)的阳性结果,评估与链霉素和乙胺丁醇耐药相关的危险因素。结果在被纳入的2941例HRM阳性病例中,18.4%对链霉素耐药,8.0%对乙胺丁醇耐药,男性对链霉素和乙胺丁醇耐药率均高于女性(19.0%vs 16.9%,P=0.129;8.0%vs 7.9%,P=0.987),城市群体高于乡村(21.3%vs 16.6%,P=0.002;9.8%vs 6.9%,P=0.004),复诊群体远高于初诊患者(25.8%vs 17.3%,P<0.001;12.1%vs 7.4%,P=0.002),年龄<51岁群体链霉素耐药率高于年龄>50岁的群体(21.1%vs 16.1%,P<0.001)。按年龄分层,链霉素及乙胺丁醇最高耐药率,男性分别出现在31~35岁和56~60岁,而女性则分别出现在21~25岁及56~60岁。多变量模型中,在调整了涂片结果和年份检测后,既往治疗史、年龄<51岁、城镇地区与链霉素和乙胺丁醇耐药性呈正相关。结论该地区男性、既往治疗史、年龄<51岁和城镇居住群体是链霉素与乙胺丁醇耐药结核的重点监测目标。

Objective To study the resistance pattern of streptomycin and ethambutol in Mycobacterium tuberculosis in Luoyang area,guide clinical medication and supplement epidemiological data on local drug-resistant tuberculosis.Methods The positive results of high-resolution melting curve(HRM)in 2941 cases in Luoyang area were analyzed to assess the risk factors associated with streptomycin and ethambutol resistance.Results Of the 2941 HRM-positive patients,18.4% were resistant to streptomycin and 8.0% were ethambutol.Both streptomycin and ethambutol and resistance rates were higher in men than those in women(19.0%vs 16.9%,P=0.129;8.0%us 7.9%,P=0.987).The resistance rates to streptomycin and ethambutol were higher in urban than those in rural areas(21.3%vs 16.6%,P=0.002;9.8%vs 6.9%,P=0.004).The resistance rate was much higher in previously treated patients than those newly diagnosed for MTB infection(25.8%s 17.3%,P<0.001;12.1%vs 7.4%,P=0.002).The resistance rates to streptomycin were higher in the<51 years than those in the>50 years group(21.1%us 16.1%,P<0.001).According to age,the highest resistance rates to streptomycin and ethambutol occurred in the age range of 31-35 years and 56-60 years in men,respectively,while in the age range of 21-25 years and 56-60 years in women,respectively.In multivariate models,prior treatment history,age less than 51 years,and urban area were positively associated with streptomycin and ethambutol resistance after adjusting for smear results and year testing.Conclusion Men,prior treatment history,age less than 51 years,and urban residents are key monitoring targets for streptomycin and ethambutol resistant tuberculosis.