臺州地區結核分枝桿菌利福平和異煙肼耐藥基因的流行病學調查

蔡鶯鶯 石慶新 周秋菊 丁仙紅 陳佳喜 涂茜 王冬蓮

[關鍵詞] 結核病;異煙肼;利福平;耐藥基因

[中圖分類號] R446.5? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）20-0146-04

Epidemiological investigation of resistance genes of rifampicin and isoniazid of Mycobacterium tuberculosis in Taizhou area

CAI Yingying1，2? ?SHI Qingxin1，2? ?ZHOU Qiuju1，2? ?DING Xianhong1，2? ?CHEN Jiaxi1，2? ?TU Xi1， 2? ?WANG Donglian1，2

1.Department of Clinical Laboratory，Taizhou Hospital of Zhejiang Province，Linhai? ?317000，China;2.Department of Clinical Laboratory，Enze Hospital of Taizhou Enze Medical Center，Taizhou? ?318053，China

[Abstract] Objective To understand the phenotype of resistance genes of rifampicin and isoniazid of Mycobacterium tuberculosis prevalent in Taizhou area，and to provide evidence for effective treatment of tuberculosis. Methods A total of 482 clinical isolates of Mycobacterium tuberculosis strains sent to and examined in Enze Hospital of Taizhou Enze Medical Center （Group） from August 2015 to November 2020 were analyzed retrospectively.Rifampicin resistance related gene in rpoB， isoniazid resistance related genes in katG and inhA were detected in specificity by DNA microarray chip method. Results In 482 cases of Mycobacterium tuberculosis， 367 cases of rpoB wild type and 115 cases of rpoB mutation-type were detected in rifampicin resistance gene， in which rpoB531（C→T） mutation was the main mutation-type，and 55 cases were detected. 372 cases of katG and InhA wild-type and 110 cases of mutation-type were detected in isoniazid resistance gene. In katG gene mutants， 91 cases were katG315（G→C） mutation and 12 cases were katG315（G→A） mutation. There were only 16 cases of inhA-15（C→T） mutation in inhA gene mutants. In 2020， the resistance rate of rifampicin gene increased to 38.46%， while the resistance rate of isoniazid gene did not increase significantly for 6 years. Conclusion The resistant genotypes of rifampicin and isoniazid of Mycobacterium tuberculosis in Taizhou area is mainly the wild type，but the resistance rate of rifampicin gene is on the rise.

[Key words] Tuberculosis; Isoniazid; Rifampicin; Resistance gene

耐藥結核是全球公共衛生問題[1-4]。2018年全球新增利福平耐藥結核病病例約50萬[1];其中，我國是全球耐藥結核病負擔最大的三個國家之一。耐多藥/利福平耐藥結核病的確診需要細菌學、痰培養、分子診斷、基因測序等手段[5]。結核病患者確診后需要接受至少9～20個月的二線抗結核藥物治療[1]，更需要精準的用藥指導。通過分子診斷技術檢測結核分枝桿菌耐藥基因，可快速準確判斷耐藥情況，提示臨床醫生根據耐藥結果選用合適藥物，不僅可以輔助臨床選擇最佳治療方案，實行個體化醫療，也可以縮短療程、降低醫療費用，從而減輕患者和社會的負擔[6]。目前，尚無臺州地區結核分枝桿菌利福平和異煙肼耐藥基因流行病學的分析報道。恩澤醫院是臺州地區結核病定點醫院，標本來源廣泛，日常檢測量大。