临床肺结核治疗中耐药性分析及对策

Resistant Analysis and Countermeasures in Clinical tuberculosis treatment

目的:了解从分离自肺结核患者的结核分枝杆菌耐药基因突变率及耐药情况,以利抗结核治疗中药物的合理选用。方法:对痰涂片阳性的新发初治和复治肺结核患者进行痰结核分枝杆菌培养,阳性菌株采用高、低两种药物浓度,四种抗结核药物耐药性测试,同时用实时PCR法对结核分枝杆菌的耐药基因和突变进行检测。结果:127例痰培养阳性菌株总耐药率为14.2%,其中初治耐药率8.1%,复治耐药率35.7%,对四种抗结核药物的耐药率依次为异烟肼8.7%,利福平2.4%,链霉素2.4%,乙胺丁醇0.8%。耐药基因检测结果,在初治组中rpoB和katG的突变率为12.1%(12/99)和10.1%(10/99);复治组中rpoB和katG的突变率为32.1%(9/28)和21.4%(6/28)。结论:分离自肺结核患者的结核分枝杆菌在初始治疗时已存在耐药性,而药物治疗有可能使其耐药性增加。结果表明抗结核治疗前及在治疗过程中对结核分枝杆菌进行耐药性及耐药基因检测对指导临床抗结核治疗很有实际意义。

Objective To make a reasonable choice in understanding the gene mutation rate and resistance to anti-tuberculosis drugs from isolation of patients with pulmonary resistant Mycobacterium tuberculosis.Methods Sputum smear positive governance of new tuberculosis patients and re-treated ones were conducted sputum mycobacterium tuberculosis culture;positive mycobacterium using high and low concentration and testing four anti-tuberculosis drugs resistance,to detect the resistant gene and the mutation rate of mycobacterium tuberculosis using real-time PCR.Results Resistant rate of 127 cases sputum culture positive was 14.2%,resistant rate of initial treatment was 8.1%,that was 35.7% for retreated;Drug resistance rates of four anti-tuberculosis were 8.7% of isoniazid,rifampicin 2.4%,2.4% streptomycin,ethambutol 0.8%;The mutations rates of katG mutations in rpoB rate in resistance gene test in the untreated group was 12.1%(12/99) and 10.1%(10/99),The mutations rates of katG mutations in rpoB rate in retreated group was 32.1%(9 / 28) and 21.4%(6 / 28).Conclusion Mycobacterium isolated from patients with pulmonary tuberculosis in the initial treatment has deveioped resistance,and drug therapy may increase their resistance.The results show that analysis of mycobacterium tuberculosis of drug resistance and resistance to genetic testing can play practical significance in anti-tuberculosis treatment before and during the treatment.