摘要
目的了解263例结核病并发HIV感染患者的MTB耐药率、耐药谱及耐药基因的分布,为临床治疗提供指导和帮助。方法收集2017年7月1日至2019年6月30日于成都市公共卫生临床医疗中心确诊为结核病并发HIV感染、符合纳入与排除标准的263例患者作为研究对象。采用BACTEC MGIT 960鉴定系统进行菌种鉴定,微孔板比例法进行药物敏感性试验(简称"药敏试验"),DNA微阵列芯片法检测耐药基因。对患者的耐药率、耐药谱及耐药基因分布等方面进行分析。结果263例结核病并发HIV感染患者,共计78例发生MTB耐药,总体耐药率为29.7%,耐药顺位依次如下:INH(14.8%,39/263)、RFP(11.0%,29/263)、Sm(8.4%,22/263)、Mfx(6.5%,17/263)、Rfb(6.1%,16/263)、Lfx(4.6%,12/263)、EMB(4.2%,11/263)、Pto(3.4%,9/263)、PAS(3.0%,8/263)。复治结核病并发HIV感染者耐药率为57.4%(35/61),明显高于初治结核病并发HIV感染者[21.3%(43/202)],差异有统计学意义(χ~2=29.25,P=0.000)。对INH耐药的耐药基因突变顺位依次为katG24株(68.6%,24/35)、inhA11株(31.4%,11/35);对RFP耐药的耐药基因突变位点顺位依次为rpoB 531位点16株(61.5%,16/26),rpoB526位点7株(26.9%,7/26),rpoB516位点3株(11.5%,3/26)。结论结核病并发HIV感染患者耐药率较高,以耐一线抗结核药品为主,对RFP耐药以rpoB531位点突变最为常见,对INH耐药以katG基因突变常见。
Objective To investigate the MTB resistance rate,resistance spectrum and distribution of resistance genes in tuberculosis and HIV co-infection patients to provide guidance for clinical treatment.Methods A total of 263 patients with tuberculosis and HIV co-infection who met the inclusion and exclusion criteria in Chengdu Public Health Clinical Center from July 1,2017 to June 30,2019 were collected as the research objects.BACTEC MGIT 960 identification system was used for bacterial type identification,microplate proportion method was used for drug sensitivity test,and DNA microarray chip was used to detect drug resistance genes.The drug resistance rate,spectrum and gene distribution were analyzed among these patients.Results Among the 263 tuberculosis patients complicated with HIV infection,a total of 78 cases developed MTB resistance,with an overall drug resistance rate of 29.7%.The distributions of anti-tuberculosis drug resistance were as follows:INH(14.8%,39/263),RFP(11.0%,29/263),Sm(8.4%,22/263),Mfx(6.5%,17/263),Rfb(6.1%,16/263),Lfx(4.6%,12/263),EMB(4.2%,11/263),Pto(3.4%,9/263),PAS(3.0%,8/263).The incidence of drug resistance in retreatment tuberculosis complicated with HIV infection was 57.4%(35/61),which was significantly higher than that in initial treatment tuberculosis complicated with HIV infection(21.3%,43/202),and the difference was statistically significant(χ^2=29.25,P=0.000).The drug resistance gene mutation of INH in katG were 24 strains(68.6%,24/35)and 11 strains in inhA(31.4%,11/35);the drug resistance gene mutation of RFP in rpoB 531 were 16 strains(61.5%,16/26),7 strains(26.9%,7/26)in rpoB 526,and 3 strains(11.5%,3/26)in rpoB516.Conclusion The drug resistance rate of tuberculosis and HIV co-infection patients was higher,and distribution of the anti-tuberculosis drugs were mainly the first-line drugs.The rpoB531 mutations are the most common in RFP resistance,and katG mutations are common in INH resistance.
作者
傅小燕
黄涛
陈晴
何畏
黄晓秋
吴桂辉
FU Xiao-yan;HUANG Tao;CHEN Qing;HE Wei;HUANG Xiao-qiu;WUGui-hui(Department of Tuberculosis,Public Health Clinical Center of Chengdu,Chengdu 610061,China)
出处
《结核与肺部疾病杂志》
2020年第2期55-59,共5页
Journal of Tuberculosis and Lung Disease
基金
四川省医学会课题项目(S18027)
关键词
结核
肺
HIV感染
共病现象
结核
抗多种药物性
基因型
突变
研究报告
Tuberculosis,pulmonary
HIV infections
Comorbidity
Tuberculosis,multidrug-resistant
Genotype
Mutation
Research report
作者简介
第一作者:傅小燕对本文有同等贡献;第一作者:黄涛对本文有同等贡献;通信作者:吴桂辉,Email:wghwgh2584@sina.com
