CAJ | 학술논문

目的使用分子线性探针杂交技术结合仪器法液体快速培养分析耐多药( multidrug resistant,MDR)及广泛耐药(extensively drug resistant,XDR)结核分枝杆菌(Mycobacterium tuberculosis,MTB)的耐药基因和表型特征.方法运用GenoType MTBDR试剂盒检测M/XDR-TB菌株中各耐药基因的突变位点及类型,平行用BD MGIT960系统检测所选菌株对一线及二线抗结核药物的敏感性.结果 (1)94株MDR-TB经MGIT960检测,乙胺丁醇(ethambutol,EMB)、阿米卡星(amikacin,AMK)、氧氟沙星(ofloxacin,OFX)及莫西沙星(moxifloxacin,MFX)的耐药率分别为36.2%、17.0%、54.3%和55.3%.XDR-TB检出率为13.8%.(2)以MGIT960药敏结果作为参考标准,94株MDR-TB中,GenoType MTBDRplus检测MTB对异烟肼(isoniazid,INH)、利福平(rifampin,RFP)耐药的符合率分别为86.2%和95.7%；GenoType MTBDRsl检测MTB对EMB、AMK、OFX及MFX耐药的敏感性分别为47.1%、81.3%、94.1%、94.2%；特异性分别为75.0%、98.7%、90.7%、92.9%.(3)rpoB基因突变中以S531L最多；INH耐药主要由katG基因发生突变导致,以S315T1类型居多；gyrA突变位点主要集中在第94位密码子.所测菌株中有23例为复合耐药,7例为未知突变.结论 M/XDR-TB中,INH、RFP、AMK、OFX及MFX耐药株大多分别是由katG、rpoB、rrs及gyrA突变导致,乙胺丁醇与embB之间的耐药关联性相对较低.GenoType MTBDR试剂盒检测M/XDR-TB敏感性和特异性较好,可以在未获得传统细菌表型药敏结果前指导临床用药治疗.
목적 사용분자선성탐침잡교기술결합의기법액체쾌속배양분석내다약( multidrug resistant,MDR)급엄범내약(extensively drug resistant,XDR)결핵분지간균(Mycobacterium tuberculosis,MTB)적내약기인화표형특정.방법 운용GenoType MTBDR시제합검측M/XDR-TB균주중각내약기인적돌변위점급류형,평행용BD MGIT960계통검측소선균주대일선급이선항결핵약물적민감성.결과 (1)94주MDR-TB경MGIT960검측,을알정순(ethambutol,EMB)、아미잡성(amikacin,AMK)、양불사성(ofloxacin,OFX)급막서사성(moxifloxacin,MFX)적내약솔분별위36.2%、17.0%、54.3%화55.3%.XDR-TB검출솔위13.8%.(2)이MGIT960약민결과작위삼고표준,94주MDR-TB중,GenoType MTBDRplus검측MTB대이연정(isoniazid,INH)、리복평(rifampin,RFP)내약적부합솔분별위86.2%화95.7%；GenoType MTBDRsl검측MTB대EMB、AMK、OFX급MFX내약적민감성분별위47.1%、81.3%、94.1%、94.2%；특이성분별위75.0%、98.7%、90.7%、92.9%.(3)rpoB기인돌변중이S531L최다；INH내약주요유katG기인발생돌변도치,이S315T1류형거다；gyrA돌변위점주요집중재제94위밀마자.소측균주중유23례위복합내약,7례위미지돌변.결론 M/XDR-TB중,INH、RFP、AMK、OFX급MFX내약주대다분별시유katG、rpoB、rrs급gyrA돌변도치,을알정순여embB지간적내약관련성상대교저.GenoType MTBDR시제합검측M/XDR-TB민감성화특이성교호,가이재미획득전통세균표형약민결과전지도림상용약치료.
Objective To analyze the characterstics of phenotype and genotype of multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) by molecular line probe assay and liquid culture with MGIT960.Methods GenoType MTBDR Kits were used for identifying the types of the first-line and second-line antituberculosis drug resistant genes partly and BD MGIT960 was used for detecting the chug susceptibility.Results ( 1 ) Out of 94 MDR-TB strains,the rate of drug resistant to EMB,AMK,OFX and MFX by BD MGIT960 assay were 36.2%,17.0%,54.3% and 55.3%,respectively.Among these isolates,13 were extensively drug resistant tuberculosis (XDR-TB).(2) Compared with MGIT960,the concordance rate of GenoType MTBDRplus was 86.2% and 95.7% respectively.Taking MGIT960 results as reference,the sensitivity of GenoType MTBDRsl detecting the susceptibility of EMB,AMK,OFX and MFX to 94 isolates were 47.1%,81.3%,94.1%,94.2%,respectively.The specificity were 75.0%,98.7%,90.7%,92.9%,respectively.(3) Among the rpoB mutation categories,S531L accounts for most.MTB resistant to IFN caused by the mutation of katG chiefly and the S315T1 was in the majority.The gyrA mutation sites located at the ninety-fourth codon most.Out of 94 strains,23 were mixed with 2 kindsof Mycobacterium tuberculosis at least and 7 were undetectable mutations.Conclusion Among the M/XDR-TB,the strains resistant to INH,RFP,AMK,OFX and MFX were caused most by the mutation of katG,rpoB,rrs and gyrA,respectively.The relationship between EMB and embB was not so clear relatively.As a fast detecting drug susceptibility test kit,GenoType MTBDR possess good sensitivity and specificity.So,it could be as an assistant method to guide the therapy on clinic.