CAJ | 학술논문

目的：分析镇江地区结核分枝杆菌的DNA指纹图谱分型及耐药情况。方法收集174例疑似结核病患者痰液标本，通过鉴别培养基对硝基苯甲酸（ PNB）和噻吩－2－羟酸肼（ TCH）进行分枝杆菌菌型初筛，再通过本室建立的PCR－ELISA法明确鉴定结核杆菌菌种，用比例法进行药敏实验，用DNA随机扩增多态性（ RAPD）指纹分型法，对其中44株耐药人型结核分枝杆菌进行DNA指纹图谱分型。结果从174份标本中分离出人型结核分枝杆菌141株（81．03％），牛型结核分枝杆菌20株（11．49％），非结核分枝杆菌13株（7．47％），总耐药率42．53％；耐药率由高到低依次为异烟肼（INH）＞氧氟沙星（OFX）＞利福平（RFP）＞链霉素（SM）＞乙胺丁醇（EMB）＞卡那霉素（KM）＞卷曲霉素（ CPM）＞阿米卡星（ AKM）；非结核分枝杆菌对EMB、RFP、SM、INH的耐药率显著高于结核分枝杆菌（ P＜0．01）。复治组对EMB、RFP、SM、INH的耐药率显著高于初治组的耐药率（P＜0．01）。中、老年患者耐药率明显高于青年患者（P＜0．05或P＜0．01）。将44株耐药人型结核杆菌，用RAPD－PCR分型，并用NTsys 2．10e软件作聚类分析，共分为5型（Ⅰ型～Ⅴ型），其中以Ⅰ～Ⅲ型为主，占84．09％。各型的耐药率差异无统计学意义（P＞0．05）。结论本地区肺结核以人型结核分枝杆菌为主，结核杆菌总体耐药率和耐多药率相对较高。 RAPD指纹分型结果显示，该地区结核分枝杆菌具有明显的基因多态性，成簇类型是主要流行菌株。各型与耐药性无明显相关性。
목적：분석진강지구결핵분지간균적DNA지문도보분형급내약정황。방법수집174례의사결핵병환자담액표본，통과감별배양기대초기분갑산（ PNB）화새분－2－간산정（ TCH）진행분지간균균형초사，재통과본실건립적PCR－ELISA법명학감정결핵간균균충，용비례법진행약민실험，용DNA수궤확증다태성（ RAPD）지문분형법，대기중44주내약인형결핵분지간균진행DNA지문도보분형。결과종174빈표본중분리출인형결핵분지간균141주（81．03％），우형결핵분지간균20주（11．49％），비결핵분지간균13주（7．47％），총내약솔42．53％；내약솔유고도저의차위이연정（INH）＞양불사성（OFX）＞리복평（RFP）＞련매소（SM）＞을알정순（EMB）＞잡나매소（KM）＞권곡매소（ CPM）＞아미잡성（ AKM）；비결핵분지간균대EMB、RFP、SM、INH적내약솔현저고우결핵분지간균（ P＜0．01）。복치조대EMB、RFP、SM、INH적내약솔현저고우초치조적내약솔（P＜0．01）。중、노년환자내약솔명현고우청년환자（P＜0．05혹P＜0．01）。장44주내약인형결핵간균，용RAPD－PCR분형，병용NTsys 2．10e연건작취류분석，공분위5형（Ⅰ형～Ⅴ형），기중이Ⅰ～Ⅲ형위주，점84．09％。각형적내약솔차이무통계학의의（P＞0．05）。결론본지구폐결핵이인형결핵분지간균위주，결핵간균총체내약솔화내다약솔상대교고。 RAPD지문분형결과현시，해지구결핵분지간균구유명현적기인다태성，성족류형시주요류행균주。각형여내약성무명현상관성。
Objective To analyse DNA fingerprint classification and the situation of drug resistance of mycobacterium tuberculosis in Zhenjiang.Methods Collected 174 cases of suspected TB patients sputum samples,and done early screening to identify bacteria mycobacterium type by differential medium of p-nitrobenzoic acid( PNB) and thiophene-2-hydroxy acid hy-drazide(TCH).And then mycobacterium tuberculosis was detected by PCR-ELISA.The susceptibility testing was conducted u-sing the proportional method by means of randomly amplified polymorphic DNA( RAPD) fingerprinting classification method to analyse DNA fingerprint classification of 44 strains of drug resistanted mycobacterium tuberculosis.Results Among the 174 strains in the study,mycobacterium tuberculosis in mycobacterium hominis 141 strains(81.03%) ,mycobacterium bovis strain 20(11.49%),13 strains of non mycobacterium tuberculosis(7.47%),the total drug resistance rate was 42.53%.Drug resist-ance rate from high to low was INH>OFX>RFP>SM>EMB>KM>CPM>AKM.Non mycobacterium tuberculosis resistant to EMB,RFP,SM,INH were significantly higher than those of mycobacterium tuberculosis.The retreatment group resistance to EMB,RFP,SM,INH were significantly higher than the initial drug resistance rate of the treatment group.In elderly patients, drug resistance rate was higher than that in young patients.44 strains of drug resistanted mycobacterium tuberculosis were di-vided into 5 types by RAPD-PCR classification method,and clustering analysis with NTsys 2.10e software.Type Ⅰ,type Ⅱand typeⅢ are the main types which are accounting for 84.09%.Conclusion Mycobacterium tuberculosis in Zhenjiang mainly is mycobacterium hominis.The prevalence of drug resistance tuberculosis in Zhenjiang was relatively high.There is ob-vious genetic polymorphism in the mycobacterium tuberculosis in Zhenjiang area by RAPD-PCR.And the clustering type was perhaps the main epidemic strains.There was no significant correlation between genotype and drug resestance.