CAJ | 학술논문

目的探讨MTB北京基因型在人群中的分布及其耐药类型和相关分子特征.方法江苏省灌云县和浙江省德清县1年内登记确诊的结核病患者399例,分离出MTB菌株者351例,其中男237例,女114例;年龄18～82岁,平均(46±35)岁.采用比例法确定分离株对一线抗结核药物的耐药类型,用直接基因测序识别耐药相关的基因突变,用间隔区寡核苷酸分型技术识别MTB北京基因型,以IS6110限制性内切酶片段长度的多态性(IS6110 IS6110-RFLP)技术确定MTB基因型及其成簇性和惟一性.结果在分离得到的351株MTB菌株中北京基因型243株,北京基因型患者中耐多药、耐异烟肼和耐利福平分别占18.5%(45/243)、43.2%(105/243)和22.2%(54/243),明显高于非北京基因型[7.4%(8/108)、24.1%(26/108)和12.0%(13/108)];北京基因型菌株中rpoB和katG基因的联合突变率较高,分别为13.2%(32/243)和 4.6%(5/108),OR=2.553,95%CI为1.031～6.324;北京基因型菌株的成簇率[41.2%(100/243)]明显高于非北京基因型[11.1%(12/108)],OR=5.503,95%CI为2.851～10.622.结论在我国东部农村地区,感染北京基因型菌株的结核病患者发生耐异烟肼、耐利福平和耐多药结核病的危险性较大,其发病有可能由于近期传播所致.
목적 탐토MTB북경기인형재인군중적분포급기내약류형화상관분자특정.방법 강소성관운현화절강성덕청현1년내등기학진적결핵병환자399례,분리출MTB균주자351례,기중남237례,녀114례;년령18～82세,평균(46±35)세.채용비례법학정분리주대일선항결핵약물적내약류형,용직접기인측서식별내약상관적기인돌변,용간격구과핵감산분형기술식별MTB북경기인형,이IS6110한제성내절매편단장도적다태성(IS6110 IS6110-RFLP)기술학정MTB기인형급기성족성화유일성.결과 재분리득도적351주MTB균주중북경기인형243주,북경기인형환자중내다약、내이연정화내리복평분별점18.5%(45/243)、43.2%(105/243)화22.2%(54/243),명현고우비북경기인형[7.4%(8/108)、24.1%(26/108)화12.0%(13/108)];북경기인형균주중rpoB화katG기인적연합돌변솔교고,분별위13.2%(32/243)화 4.6%(5/108),OR=2.553,95%CI위1.031～6.324;북경기인형균주적성족솔[41.2%(100/243)]명현고우비북경기인형[11.1%(12/108)],OR=5.503,95%CI위2.851～10.622.결론 재아국동부농촌지구,감염북경기인형균주적결핵병환자발생내이연정、내리복평화내다약결핵병적위험성교대,기발병유가능유우근기전파소치.
Objective To investigate the distribution of Mycobacterium tuberculosis (MTB) Beijing genotype, which was isolated from tuberculosis (TB) patients registered in local TB dispensaries in Deqing and Guanyun county respectively within 1 year, as well as its drug-resistant phenotypic and genotypic profiles and genotyping features. Methods A total of 399 TB patients were enrolled from 2 counties. Of the 351 TB patients with MTB isolates available, 237 were male, and 114 were female; aged from 18-82 (46±35) years . The proportion method and DNA sequencing were used to define the susceptibility of the isolates to 4 first line anti-TB drugs and the related mutation. Beijing genotype MTB strains were identified by Spoligotyping, while the "cluster" strains and the "unique" strains were defined by IS6110 restriction fragment length polymorphism (RFLP). Results Beijing genotype MTB strains were identified in 243 of the 351 strains isolated, and the proportion of multi-drug resistance, mono-resistance to rifampin and isoniazid among Beijing genotype MTB was 18.5% (45/243), 43.2% (105/243) and 22.2% (54/243) respectively, all being significantly higher than the non-Beijing genotype MTB, 7.4% (8/108), 24.1% (26/108) and 12.0% (13/108) respectively. katG and rpoB mutations were observed more common among Beijing genotype MTB than among non-Beijing genotype MTB, 13.2% (32/243) and 4.6% (5/108) respectively, OR=2.553, 95%CI: 1.031-6.324. The Beijing genotype MTB was more likely to be clustered than non-Beijing genotype MTB, 41.2% (100/243) and 11.1% (12/108) respectively, OR=5.503, 95%CI: 2.851-10.622. Conclusions In eastern rural China, TB patients infected with the Beijing genotype MTB may have a higher risk to develop isoniazid-or rifampin-resistance and multi-drug resistance. The disease is more likely due to recent transmission.