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目的:了解从分离自肺结核患者的结核分枝杆菌耐药基因突变率及耐药情况,以利抗结核治疗中药物的合理选用。方法:对痰涂片阳性的新发初治和复治肺结核患者进行痰结核分枝杆菌培养,阳性菌株采用高、低两种药物浓度,四种抗结核药物耐药性测试,同时用实时PCR法对结核分枝杆菌的耐药基因和突变进行检测。结果:127例痰培养阳性菌株总耐药率为14.2%,其中初治耐药率8.1%,复治耐药率35.7%,对四种抗结核药物的耐药率依次为异烟肼8.7%,利福平2.4%,链霉素2.4%,乙胺丁醇0.8%。耐药基因检测结果,在初治组中rpoB和katG的突变率为12.1%(12/99)和10.1%(10/99);复治组中rpoB和katG的突变率为32.1%(9/28)和21.4%(6/28)。结论:分离自肺结核患者的结核分枝杆菌在初始治疗时已存在耐药性,而药物治疗有可能使其耐药性增加。结果表明抗结核治疗前及在治疗过程中对结核分枝杆菌进行耐药性及耐药基因检测对指导临床抗结核治疗很有实际意义。
OBJECTIVE: To understand the mutation rates and drug resistance of Mycobacterium tuberculosis-resistant genes isolated from patients with pulmonary tuberculosis and to facilitate the rational selection of Chinese medicines for anti-TB treatment. Methods: Mycobacterium smegmatis was cultured in newly diagnosed and retreated tuberculosis patients with positive sputum smear. The positive strains were treated with high and low drug concentration and four kinds of anti-tuberculosis drug resistance test. Meanwhile, real-time PCR Act on Mycobacterium tuberculosis resistance genes and mutations were detected. Results: The total drug resistance rate of 127 sputum culture positive strains was 14.2%, of which the initial drug resistance rate was 8.1% and the rate of retargeted drug resistance was 35.7%. The resistance rates of the four antituberculosis drugs were isoniazid: 8.7% Rifampicin 2.4%, streptomycin 2.4%, ethambutol 0.8%. The results showed that the mutation rates of rpoB and katG in primary treatment group were 12.1% (12/99) and 10.1% (10/99) respectively. The mutation rates of rpoB and katG in retreatment group were 32.1% (9 / 28) and 21.4% (6/28). CONCLUSIONS: Mycobacterium tuberculosis isolated from patients with tuberculosis is already resistant to initial treatment, and drug treatment may increase its resistance. The results show that anti-tuberculosis treatment before and during the treatment of Mycobacterium tuberculosis drug resistance and drug resistance gene testing for clinical anti-TB treatment of great practical significance.