本文選題：利福平　切入點(diǎn)：異煙肼　出處：《天津醫(yī)藥》2016年09期 　論文類型：期刊論文

【摘要】：目的探討基因芯片法檢測耐多藥結(jié)核分枝桿菌臨床分離株耐藥相關(guān)基因rpo B、kat G和inh A突變的特點(diǎn),評估其臨床應(yīng)用價(jià)值。方法選取2013—2014年石家莊地區(qū)耐多藥結(jié)核分枝桿菌臨床分離株76株,采用基因芯片法檢測rpo B、kat G及inh A基因耐藥突變位點(diǎn)及頻率,以比例法藥敏結(jié)果為金標(biāo)準(zhǔn),評價(jià)基因芯片法檢測菌株耐藥的準(zhǔn)確度、靈敏度和特異度,Kappa檢驗(yàn)評價(jià)基因芯片法和比例法藥敏結(jié)果的一致性。結(jié)果在76株石家莊地區(qū)耐多藥結(jié)核分枝桿菌臨床分離株中,69株檢測到kat G/inh A基因發(fā)生單一或聯(lián)合突變,其中kat G基因優(yōu)勢突變位點(diǎn)為315,占89.9%(62/69),5.8%(4/69)存在inh A-15(C→T)突變,4.3%(3/69)發(fā)生kat G 315位點(diǎn)和inh A啟動(dòng)子區(qū)域的聯(lián)合突變。73株檢測到rpo B基因發(fā)生突變,優(yōu)勢突變位點(diǎn)為531,占64.4%(47/73);其次是526,突變率為15.1%(11/73);12.3%(9/73)發(fā)生516位點(diǎn)突變;1.4%(1/73)發(fā)生513位點(diǎn)突變;1.4%(1/73)發(fā)生533位點(diǎn)突變;另有5.5%(4/73)發(fā)生多位點(diǎn)的聯(lián)合突變。以比例法藥敏結(jié)果為金標(biāo)準(zhǔn),基因芯片法檢測利福平耐藥的敏感度為96.1%(73/76),特異度為100.0%(50/50),總準(zhǔn)確度為97.6%(123/126);檢測異煙肼耐藥的敏感度為90.8%(69/76),特異度為100.0%(50/50),總準(zhǔn)確度為94.4%(119/126);基因芯片法檢測耐多藥結(jié)核的敏感度為86.8%(66/76),特異度為100.0%(50/50),總準(zhǔn)確度為92.1%(116/126)。結(jié)論本地區(qū)耐多藥結(jié)核分枝桿菌耐藥相關(guān)基因優(yōu)勢突變類型為kat G基因315位點(diǎn)和rpo B基因531位點(diǎn),基因芯片法可快速、有效診斷耐多藥結(jié)核病。
[Abstract]:Objective to investigate the characteristics of multidrug resistant Mycobacterium tuberculosis (MDR-M) clinical isolates using gene chip method to detect the mutations of drug-resistant related genes rpo Bnkat G and inh A. Methods 76 clinical isolates of Mycobacterium tuberculosis in Shijiazhuang area from 2013 to 2014 were selected to detect the mutation sites and frequencies of drug resistance in rpo Bu Kat G and inh A genes by gene chip assay. To evaluate the accuracy of gene chip method in the detection of drug resistance of strains, the results of proportional drug sensitivity were used as gold standard. The sensitivity and specificity of Kappa test were consistent with those of gene chip assay and proportional method. Results 69 of 76 clinical isolates of multidrug resistant Mycobacterium tuberculosis in Shijiazhuang were found to have a single or combined mutation of kat Gr / inh A gene. The dominant mutation site of kat G gene is 315, accounting for 89.9%. 鈫扵he mutation of rpo B gene was detected in the co-mutation of kat G315 locus and inh A promoter region. The dominant mutation locus was 531, accounting for 64.40.47 / 73; the second was 526, with a mutation rate of 15.11.11 / 73 / 12.30.The 516 locus mutation occurred 516 locus mutation 1.4 / 73) 533 locus mutation occurred, and 533 locus mutation occurred at 5.54r73). The results of proportional drug sensitivity were used as the gold standard. The sensitivity of gene chip assay for rifampicin resistance was 96. 1 / 73 / 76, the specificity was 10. 0 / 50 / 50, the total accuracy was 97. 6 / 123 / 126; the sensitivity for detecting isoniazid resistance was 90.8 / 69 / 76, the specificity was 10. 0 / 50 / 50 and the total accuracy was 94. 44 / 119 / 126; the sensitivity of gene chip method for multidrug resistant tuberculosis was 94. 4 / 19 / 126. The specificity was 100.050 / 50 and the total accuracy was 92.1a / 116 / 1260.Conclusion the dominant mutation types of drug-resistance related genes of Mycobacterium tuberculosis in this area are kat G gene 315 locus and rpo B gene 531 locus. Gene chip method is rapid and effective in the diagnosis of multi-drug resistant tuberculosis.
【作者單位】： 石家莊市第五醫(yī)院檢驗(yàn)科;
【基金】：河北省衛(wèi)生廳計(jì)劃性課題(20150155)
【分類號】：R52;R440

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