Lee Joo Hee, Jo Kyung Wook, Shim Tae Sun
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Tuberc Respir Dis (Seoul). 2019 Apr;82(2):143-150. doi: 10.4046/trd.2018.0027. Epub 2018 Sep 28.
The purpose of this study was to analyze the relationship between the gene mutation patterns by the GenoType MTBDR (MTBDR) assay and the phenotypic drug susceptibility test (pDST) results of isoniazid (INH) and prothionamide (Pto).
A total of 206 patients whose MTBDR assay results revealed or mutations were enrolled in the study. The pDST results were compared to mutation patterns on the MTBDR assay.
The and mutations were identified in 68.0% and 35.0% of patients, respectively. Among the 134 isolated mutations, three (2.2%), 127 (94.8%) and 11 (8.2%) were phenotypically resistant to low-level INH, high-level INH, and Pto, respectively. Among the 66 isolated mutations, 34 (51.5%), 18 (27.3%) and 21 (31.8%) were phenotypically resistant to low-level INH, high-level INH, and Pto, respectively. Of the 34 phenotypic Pto resistant isolates, 21 (61.8%), 11 (32.4%), and two (5.9%) had , , and both gene mutations.
It is noted that Pto may still be selected as one of the appropriate multidrug-resistant tuberculosis regimen, although mutation is detected by the MTBDR assay until pDST confirms a Pto resistance. The reporting of detailed mutation patterns of the MTBDR assay may be important for clinical practice, rather than simply presenting resistance or susceptibility test results.
本研究旨在分析基因分型MTBDR（MTBDR）检测的基因突变模式与异烟肼（INH）和丙硫异烟胺（Pto）的表型药物敏感性试验（pDST）结果之间的关系。
共有206例MTBDR检测结果显示 或 突变的患者纳入本研究。将pDST结果与MTBDR检测的突变模式进行比较。
分别在68.0%和35.0%的患者中检测到 和 突变。在134例分离出的 突变中，分别有3例（2.2%）、127例（94.8%）和11例（8.2%）对低水平INH、高水平INH和Pto表型耐药。在66例分离出的 突变中，分别有34例（51.5%）、18例（27.3%）和21例（31.8%）对低水平INH、高水平INH和Pto表型耐药。在34例对Pto表型耐药的分离株中，21例（61.8%）、11例（32.4%）和2例（5.9%）分别有 、 及两者的基因突变。
值得注意的是，在pDST确认Pto耐药之前，尽管MTBDR检测检测到 突变，但Pto仍可作为合适的耐多药结核病治疗方案之一。MTBDR检测详细的突变模式报告可能对临床实践很重要，而不仅仅是呈现耐药或敏感试验结果。
