江西省3个监测点结核分枝杆菌耐药性及耐药基因检测分析

赵竟男 江友桥 伍文华 肖岗 黄锐

赵竟男, 江友桥, 伍文华, 肖岗, 黄锐. 江西省3个监测点结核分枝杆菌耐药性及耐药基因检测分析[J]. 疾病监测. doi: 10.3784/jbjc.202107140397
引用本文: 赵竟男, 江友桥, 伍文华, 肖岗, 黄锐. 江西省3个监测点结核分枝杆菌耐药性及耐药基因检测分析[J]. 疾病监测. doi: 10.3784/jbjc.202107140397
Zhao Jingnan, Jiang Youqiao, Wu Wenhua, Xiao Gang, Huang Rui. Drug resistance and drug resistance genes of Mycobacterium tuberculosis in three surveillance areas in Jiangxi[J]. Disease Surveillance. doi: 10.3784/jbjc.202107140397
Citation: Zhao Jingnan, Jiang Youqiao, Wu Wenhua, Xiao Gang, Huang Rui. Drug resistance and drug resistance genes of Mycobacterium tuberculosis in three surveillance areas in Jiangxi[J]. Disease Surveillance. doi: 10.3784/jbjc.202107140397

江西省3个监测点结核分枝杆菌耐药性及耐药基因检测分析

doi: 10.3784/jbjc.202107140397
基金项目: 江西省卫健委科技项目(No. 20204833);江西省自然科学基金(No. 20202BABL206125)
详细信息
    作者简介:

    赵竟男,女,吉林省浑江市人,主管技师,主要从事结核分枝杆菌检测

    通讯作者:

    赵竟男,Tel:0791–88335746,Email:285265066@qq.com

  • 中图分类号: R211;R183.3;R521

Drug resistance and drug resistance genes of Mycobacterium tuberculosis in three surveillance areas in Jiangxi

Funds: This study was supported by the Science and Technology Project of Jiangxi Provincial Health Commission (No. 20204833) and the Natural Science Foundation of Jiangxi Province (No. 20202BABL206125)
  • 摘要:   目的  了解江西省大余县、进贤县和广丰区3个国家级结核病耐药监测点确诊病例的分枝杆菌分离菌株耐药性及耐药基因突变情况,为耐药结核病防治策略制定提供科学依据。  方法  采用罗氏药敏方法测定结核分枝杆菌的耐药性,并采用PCR-线性杂交酶法进行表型耐药菌株耐药基因检测。  结果  2019年3个监测点共纳入病例280例。 获得264株分离菌株,250株为结核分枝杆菌,14株为非结核分枝杆菌。 3个监测点的分离株总耐药率、单耐药率、多耐药率、耐多药率分别为25.6%(64/250)、16.8%(42/250)、3.2%(8/250)、5.6%(14/250);男性分离株耐药检出率高于女性;S315T1是本地区异烟肼耐药基因突变的主要型别,gyrA基因突变是江西省结核分枝杆菌对氟喹诺酮类药物耐药的主要基因。  结论  使用PCR-线性杂交酶法筛查一线药、二线药耐药基因突变,对确定治疗方案及结核病的防控有重要意义。 江西省要加强对耐药结核病患者的管理,控制传染源,从而减少耐药菌株的产生和传播。
  • 表  1  2019年江西省3个监测点结核病例纳入情况

    Table  1.   Tb cases included in the three surveillance areas in Jiangxi, 2019

    监测点病例数
    (例)
    阳性数
    (例)
    阳性率a
    (%)
    结核分枝
    杆菌复合
    群(例)
    非结核
    分枝杆菌
    (例)
    大余县 70 5882.86 55 3
    进贤县12712598.43119 6
    广丰区 83 8197.59 76 5
    合计28026494.2925014
    下载: 导出CSV

    表  2  耐药模式分布

    Table  2.   Distribution of resistance patterns

    结核耐
    药模式
    初治
    (例)
    复治
    (例)
    耐受药物数量
    (例)
    构成比
    (%)
    单耐药35 7利福平 3 4.69
    异烟肼13 20.31
    乙胺丁醇 2 3.13
    卡那霉素 2 3.13
    氧氟沙星22 34.38
    多耐药 5 3异烟肼+氧氟沙星 4 6.25
    异烟肼+乙胺丁醇+
    卡那霉素
    1 1.56
    异烟肼+乙胺丁醇+
    卡那霉素+氧氟沙星
    1 1.56
    异烟肼+乙胺丁醇+
    氧氟沙星
    1 1.56
    利福平+乙胺丁醇+
    卡那霉素
    1 1.56
    耐多药11 3利福平+异烟肼 5 7.81
    利福平+异烟肼+
    乙胺丁醇
    4 6.25
    利福平+异烟肼+
    卡那霉素
    4 6.25
    利福平+异烟肼+
    乙胺丁醇+氧氟沙星
    1 1.56
    合计511364100.00
    下载: 导出CSV

    表  3   2019 年江西省 3 个监测点耐药情况的比较

    Table  3.   Comparison of drug resistance in three surveillance areas in Jiangxi, 2019

    监测点结核分枝杆菌
    复合群(例)
    总耐药单耐药多耐药耐多药利福平耐药
    大余县 55 9(16.36) 4(7.27) 3(5.45)2(3.64)4(7.27)
    进贤县11938(31.93)26(21.85)3(2.52)8(6.72)9(7.56)
    广丰区 7617(22.37)12(15.79)2(2.63)4(5.26)5(6.58)
    χ25.3865.7971.2850.5740.086
    P0.0680.0550.5790.7750.967
      注:括号内数据为耐药率(%),括号外数据为耐药数(例)
    下载: 导出CSV

    表  4  3个监测点不同年份耐药率比较

    Table  4.   Comparison of drug resistance rates in three surveillance areas in different years

    年份结核分枝杆菌
    复合群(例)
    总耐药单耐药耐多药多耐药利福平耐药
    200714347(32.87)24(16.78)12(8.39)11(7.69)12(8.39)
    201328377(27.21)30(10.60)11(3.89)10(3.53)15(5.30)
    201925064(25.60)42(16.80)14(5.60) 8(3.20)18(7.20)
    χ22.4815.1793.7385.1491.649
    P0.2890.0750.1540.0760.438
      注:括号内数据为耐药率(%),括号外数据为耐药数(例)
    下载: 导出CSV

    表  5  不同因素对结核耐药的影响(n=250)

    Table  5.   Influence of different factors on drug resistance of TB (n=250)

     因素病例数(例)耐药数(例)χ2P
    年龄组(岁)
          <201012.7610.43
          20~367
          40~8425
          >6012031
    性别
    男性208606.850.009
    女性424
    治疗类型
          初治213512.0730.15
          复治3713
    下载: 导出CSV

    表  6  不同年龄、性别耐药病例分布情况

    Table  6.   Age and gender specific distributions of drug resistant TB cases

    年龄组
    (岁)
    男性(n=208)女性(n=42)
    耐药数
    (例)
    耐药率
    (%)
    耐药数
    (例)
    耐药率
    (%)
    0~00.0000.00
    10~10.4800.00
    20~31.4412.38
    30~31.4400.00
    40~83.8500.00
    50~178.1700.00
    60~2210.5824.76
    70~41.9212.38
    80~20.9600.00
    合计6028.8549.52
    下载: 导出CSV

    表  7  2019年江西省3个监测点表型耐药菌株基因突变检测情况

    Table  7.   Detection of gene mutations in phenotypic drug-resistant strains of three surveillance areas in Jiangxi, 2019

    药物名称表型耐药数量(株)耐药基因突变数量(株)突变条带突变位点数量(株)
    利福平18rpoB14rpoB WT3/WT4(-)del515 1
    rpoB WT2/WT3(-)Q513P 1
    rpoB WT8(-)/MUT3S531L 4
    rpoB WT7(-)/MUT2B(+)H526D 4
    rpoBWT3/WT4(-)/MUT1(+)D516V 4
    异烟肼34katG28katG WT(-)/MUT1(+)S315T124
    katG WT(-)del315 4
    乙胺丁醇10embB 3embB WT(-)M306I 1
    embB WT(-)/MUT1BM306V 2
    卡那霉素 9rrs 5rrs WT1(-)/MUT1A1401G 5
    氧氟沙星29gyrA25gyrA MUT3CD94G 1
    gyrA MUT1/3CA90V/D94G 9
    gyrA WT3(-)/MUT3CD94G10
    gyrA WT3(-)/MUT3AD94A 1
    gyrA WT2(-)/MUT1A90V 1
    gyrA MUT1A90V 1
    gyrA MUT3A/3CD94A/D94G 1
    gyrA MUT2S91P 1
    下载: 导出CSV
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