慢性阻塞性肺疾病合并初治菌阳肺结核患者结核分枝杆菌rpoB基因突变分析

Analysis on rpoB gene mutations of mycobacterium tuberculosis in patients with COPD complicated with initial positive pulmonary tuberculosis

目的研究慢性阻塞性肺疾病(COPD,简称慢阻肺)合并初治菌阳肺结核患者结核分枝杆菌rpoB基因和其突变。方法选择经结核分枝杆菌ropB基因检测阳性患者221例,其中慢阻肺合并初治菌阳肺结核患者94例,单纯初治菌阳肺结核患者127例,对两组患者结核分枝杆菌基因(利福平耐药)进行回顾性研究。结果慢阻肺合并初治菌阳肺结核患者结核分枝杆菌rpoB基因菌株(利福平耐药)21例,占比22.3%,利福平敏感73例,占比77.7%;单纯初治菌阳肺结核患者结核分枝杆菌rpoB基因菌株(利福平耐药)15例,占比11.8%,利福平敏感112例,占比88.2%;两组对比差异有统计学意义(P<0.05),慢阻肺合并初治菌阳肺结核患者结核分枝杆菌rpoB基因(利福平耐药)率高于单纯初治菌阳肺结核组;各组不同性别利福平耐药率比较差异无统计学意义(P>0.05);各组不同年龄段基因(利福平耐药)率比较差异无统计学意义(P>0.05),但慢阻肺合并初治菌阳肺结核组在50~59岁及年龄≥70岁年龄段基因(利福平耐药)率较高,分别为33.3%、28.9%。单纯初治菌阳肺结核组以年龄<20岁利福平耐药率较高,占比28.6%。结论肺结核患者结核分枝杆菌rpoB基因突变是导致利福平耐药的原因之一,慢阻肺合并初治菌阳肺结核患者结核分枝杆菌rpoB基因突变率(利福平耐药)高于单纯初治菌阳肺结核患者;各组患者基因突变率(利福平耐药)与性别无关,慢阻肺合并初治菌阳肺结核患者年龄越高,利福平耐药率越高。

Objective To study the mycobacterium tuberculosis rpoB gene and mutations in patients with chronic obstructive pulmonary disease(COPD)combined with mycobacterium primordial-positive tuberculosis.Methods 221 patients with positive mycobacterium tuberculosis rpoB gene test were selected,including 94 patients with COPD combined with primary-positive tuberculosis and 127 patients with simple primary-positive tuberculosis,and mycobacterium tuberculosis gene mutations(rifampicin-resistant)were retrospectively investigated in the two groups.Results 21 cases of mycobacterium tuberculosis rpoB gene mutation strains(rifampicin-resistant)in patients with COPD and primary-positive pulmonary tuberculosis(PTPT),and 73 cases of wild-type strains(rifampicin-susceptible).15 cases of rpoB gene mutation strains(rifampicin-resistant)in patients with simple primary-positive PTPT.There were 15 cases of mycobacterium tuberculosis rpoB mutant strains(rifampicin-resistant)in patients with simple primary bacillus-positive pulmonary tuberculosis(11.8%)of the mutation(rifampicin-resistant)rate,and 112 cases(88.2%)of wild-type strains(rifampicin-susceptible)of the rate of wild-type strains(rifampicin-susceptible)(P<0.05).There was no statistically significant difference in the mutation(rifampicin resistance)rate by gender(P>0.05),and the difference in the mutation(rifampicin resistance)rate by age was not statistically significant(P>0.05),but in the group of patients with chronic obstructive pulmonary disease combined with primigravid pulmonary tuberculosis,the mutation(rifampicin resistance)rate in the age groups of 50~59 years old and≥70 years old was higher,which was 33.3%and 28.9%,respectively.Rifampicin resistance rate was higher in<20 years of age with 28.6%in the simple primary bacillus-positive TB group.Conclusion Mycobacterium tuberculosis rpoB gene mutation is one of the causes of rifampicin resistance in patients with tuberculosis,and the rate of mycobacterium tuberculosis rpoB gene mutation in patients with COPD combined with primary bacillus-positive tuberculosis is higher than that in patients with simple primary bacillus-positive tuberculosis.The age of patients with COPD combined with primary bacillus-positive tuberculosis is higher,the Rifampicin resistance rate is higher.