2017—2022年乐山市311例耐药结核分枝杆菌相关耐药基因变异特征分析

Analysis on variation characteristics of drug-resistant genes in 311 cases of drug-resistant mycobacterium tuberculosis in Leshan City from 2017 to 2022

目的分析乐山市2017—2022年收集得到的311例耐药结核分枝杆菌相关耐药基因突变位点特征,为本地区耐药结核病防治提供数据支持。方法采用线性杂交酶显色技术对结核分枝杆菌进行耐药检测,对RFP和INH耐药基因的突变位点与不同耐药类型的病例特征进行分析,了解耐药基因突变位点频率的分布特点。结果被纳入分析的311例耐药结核分枝杆菌,其中单耐RFP 63例(20.26%),单耐INH 126例(40.51%),耐多药122例(39.23%),按单耐RFP、单耐INH、耐多药3种类型分类后发现不同年龄组(χ^(2)=20.336,P=0.002)、不同患者类型(χ^(2)=15.496,P=0.004)、不同民族(χ^(2)=7.852,P=0.020)的耐药情况差异均有统计学意义,单耐RFP相关rpoB基因突变位点主要发生在S531L、H526Y位点,单耐INH相关katG/inhA基因突变位点主要发生在S315T1、C-15T位点,耐多药中rpoB基因和katG/inhA基因位点突变组合以S531L+S315T1为主。结论乐山地区耐药结核病应加强以中老年人群和农村人群为主体的防控策略,同时继续做好耐药结核的分子检测工作,及时掌握本地区耐药基因突变情况,为本地区耐药结核病防治提供数据支持。

Objective To analyze the characteristics of mutation sites of drug resistance genes associated with drug-resistant Mycobacterium tuberculosis in 311 cases in Leshan City from 2017 to 2022,and to provide scientific basis for the prevention and treatment of drug-resistant tuberculosis in this region.Methods The linear hybridization enzyme chromogenic technique was used to detect the drug resistance of Mycobacterium tuberculosis.The mutation sites of rifampicin(RFP)and isoniazid(INH)resistance genes and the characteristics of different drug resistance types were analyzed to understand the distribution characteristics of the frequency of drug resistance gene mutation sites.Results A total of 311 cases of drug-resistant Mycobacterium tuberculosis were included in the analysis,of which 63 cases(20.26%)were single resistant to RFP,126 cases(40.51%)were single resistant to INH,and 122 cases(39.23%)were multi-drug resistant.According to the classification of single resistance to RFP,single resistance to INH,and multi-drug resistance,it was found that the differences in drug resistance among different age groups(χ^(2)=20.336,P=0.002),different patient types(χ^(2)=15.496,P=0.004)and different nationalities(χ^(2)=7.852,P=0.020)were statistically significant.Mutation sites of rpoB gene related to single RFP resistance were mainly located at S531L and H526Y sites.Mutation sites of katG/inhA gene related to single INH resistance were mainly located at S315T1 and C-15T sites.The combination of rpoB gene and katG/inhA gene mutations was mainly S531L+S315T1 in multi-drug resistance.Conclusions The prevention and control strategies of drug-resistant tuberculosis in Leshan area should be strengthened with middle-aged,elderly and rural people as the main group,continue to do a better job of molecular detection of drug-resistant tuberculosis,grasp the mutation sites of drug-resistant genes in time and provide data support for the prevention and control of drug-resistant tuberculosis in the region.