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目的探讨尘肺并发结核患者感染的结核分支杆菌L型(MTB-L)的耐药性及耐药株基因突变情况。方法在97例淮南矿区尘肺并发结核患者中分离出MTB-L 52株,采用常规药敏试验(AST法)检测耐药性,采用聚合酶链反应-单链构象多态性分析(PCR-SSCP)法检测katG、rpoB和rpsL耐药基因突变情况。结果52株MTB-L对异烟肼(INH)、利福平(RFP)和链霉素(SM)的耐药率分别为76.92%(40/52)、90.38%(47/52)和50.00%(26/52),耐3种药物21例(40.38%),耐2种药物19例(36.54%),单耐药株12例(23.08%),耐药率100%。katG、rpoB和rpsL基因突变率分别为57.70% (30/52)、65.38%(32/52)和40.38%(21/52),52株MTB-L中有41株回复为MTB细菌型,回复率为78.85% (41/52),回复后耐药基因不变。PCR-SSCP法检出3个基因联合突变的有15株(15/52,28.84%),2个基因突变的16株(16/52,30.77%),单基因突变的6株(6/52,11.54%)。结论淮南矿区尘肺并发结核患者感染的MTB-L耐药情况严重,耐药率为100%,耐药株中存在katG、rpoB、rpsL耐药基因突变。
Objective To investigate the drug resistance of Mycobacterium tuberculosis L (MTB-L) and the mutation of drug-resistant strains in patients with pneumoconiosis complicated with tuberculosis. Methods 52 strains of MTB-L were isolated from 97 patients with tuberculosis complicated with pneumoconiosis in Huainan mining area. The drug resistance was tested by routine drug susceptibility test (AST). PCR-SSCP ) Method to detect the mutations of katG, rpoB and rpsL resistance genes. Results The resistance rates of 52 strains of MTB-L to INH, RFP and SM were 76.92% (40/52), 90.38% (47/52) and 50.00 (26/52), 21 (40.38%) were resistant to 3 drugs, 19 (36.54%) were resistant to 2 drugs and 12 (23.08%) were single drug resistant. The drug resistance rate was 100%. The mutation rates of katG, rpoB and rpsL were 57.70% (30/52), 65.38% (32/52) and 40.38% (21/52) respectively, and 41 of 52 strains of MTB-L recovered as MTB bacterium, The rate was 78.85% (41/52), no change after the resistance gene. Fifteen strains (15/52, 28.84%) were detected by PCR-SSCP, 16 strains (16/52, 30.77%) of two mutations and 6 strains of single-gene mutation , 11.54%). Conclusions The MTB-L resistance in patients with pneumoconiosis complicated with tuberculosis in Huainan mining area is serious, with a resistance rate of 100%. There are katG, rpoB and rpsL resistance gene mutations in the resistant strains.