河北医学2024,Vol.30Issue(2) :244-250.DOI:10.3969/j.issn.1006-6233.2024.02.013

乙肝合并结核分枝杆菌感染患者的结核耐药基因分布情况

Distribution of Tuberculosis Drug Resistance Genes in Patients with Hepatitis B Complicated with Mycobacterium Tuberculosis Infection

孟颖 张倩 支力强
河北医学2024,Vol.30Issue(2) :244-250.DOI:10.3969/j.issn.1006-6233.2024.02.013

乙肝合并结核分枝杆菌感染患者的结核耐药基因分布情况

Distribution of Tuberculosis Drug Resistance Genes in Patients with Hepatitis B Complicated with Mycobacterium Tuberculosis Infection

孟颖 1张倩 2支力强3
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作者信息

  • 1. 空军军医大学唐都医院临床检验科, 陕西 西安 710038
  • 2. 陕西省西安市第五医院检验科, 陕西 西安 710082
  • 3. 陕西省西安市红会医院关节外科, 陕西 西安 710054
  • 折叠

摘要

目的:探讨结核病(TB)/慢性乙型肝炎病毒(HBV)合并感染患者对一线抗结核药物耐药的频率和分子机制.方法:研究对来自TB/HBV共感染患者的 100 株结核分枝杆菌菌株进行了回顾性实验室分析,其中Beijing谱系株最为普遍(49%),其次是EAI谱系株(35%),少数菌株包括Haarlem(2.0%)、LAM(1.0%)、MANU(3.0%)、T(4.0%)和U(6.0%).所有菌株均于 2014 年至 2018 年从患者的痰、胸腔积液标本中分离.对所有菌株进行药敏试验、Spoligotyping分型和24 个位点穿插重复单元(MI-RU-24 分型),并对rpoB、katG、inhA和inhA启动子、rpsL、rrs 和 embB 基因进行测序.结果:总共有 42株(42.0%,42/100)菌株表现出耐药性;9 株(9.0%,9/100)是多重耐药株(MDR).对异烟肼的耐药率为25.0%(25/100),利福平的耐药率为 10.0%(10/100),乙胺丁醇的耐药率为 5.0%(5/100),和链霉素的耐药率为40.0%(40/100).在利福平耐药菌株中,90%(9/10)具有利福平抗性的分离株在 RRDR中具有突变(密码子507-533).在异烟肼耐药菌株中,分别有 100%和 21%的 katG 和 inhA(包括 inhA启动子)发现基因突变;其多药耐药性主要与katG基因中的Ser315Thr突变相关(7/9,77.8%).59.5%存在耐药性的菌株属于北京谱系,66.7%的MDR菌株属于北京谱系.结论:在 TB/HBV 合并感染患者的结核分枝杆菌分离株中接近一半(42%)为耐药株,其中以Beijing谱系为主.

Abstract

Objective:To examine the M.tuberculosis strain diversity and describe the frequency and molecular mechanisms of resistance against first-line TB drugs in TB/HBV co-infected patients.Methods:A total of 100 strains of Mycobacterium tuberculosis from TB/HBV co-infected patients were analyzed retrospec-tively,among which Beijing strain was the most common(49%),followed by EAI strain(35%),and a few strains included Haarlem(2.0%),LAM(1.0%),MANU(3.0%)and T(4.0%).All strains were isolated from sputum and pleural effusion samples of patients from 2014 to 2018.Drug susceptibility testing,spoligoty-ping and 24-locus Mycobacterial Interspersed Repetitive Unit(MIRU-24 typing)were performed,and the rpoB,katG,inhA and inhA promoter,rpsL,rrs and embB genes were sequenced in all drug resistant isolates identified.Results:In total,42/100(42.0%)strains showed drug resistance;9(9.0%)were multi-drug resistant(MDR).Resistance rates were 25.0%(25/100)to isoniazid,10.0%(10/100)to rifampicin,5.0%(5/100)to ethambutol,and 40.0%(40/100)to streptomycin.Among rifampicin-resistant strains,90%(9/10)of the isolates with rifampicin resistance had mutations in the RRDR(codons 507-533).A-mong isoniazid-resistant strains,mutations were found in 100%and 21%of katG and inhA(including the inhA promoter),respectively;their multidrug resistance was mainly associated with the Ser315Thr mutation in the katG gene(7/9,77.8%).59.5%of the strains with resistance belonged to the Beijing spectrum,and 66.7%of the MDR strains belonged to the Beijing spectrum.Conclusion:Nearly half(42%)of M.tubercu-losis isolates from TB/HBV co-infected patients are drug-resistant strains,among which Beijing lineage is the main strain.

关键词

结核病/结核分枝杆菌/耐药性/结核病/慢性乙型病毒性肝炎联合感染

Key words

Tuberculosis/Mycobacterium tuberculosis/Drug resistance/TB/HBV co-infection

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基金项目

陕西省社会发展领域项目(2020SF-090)

出版年

2024
河北医学
河北省医学会

河北医学

CSTPCD
影响因子:1.915
ISSN:1006-6233
参考文献量8
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