北京基因型结核分枝杆菌的流行情况及其与二线抗结核药物耐药性的关系研究

Liang C, Zhang X X, Xing Q, Yi J L, Zhang Y Q, Li C Y, Liu Y, Tang S J

Department of Bacteriology and Immunology, Capital Medical University, Beijing Chest Hospital/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.

Central Laboratory, Beijing Research Institute for Tuberculosis Control, Xicheng District, Beijing 100035, China.

Zhonghua Jie He He Hu Xi Za Zhi. 2020 Apr 12;43(4):356-361. doi: 10.3760/cma.j.cn112147-20191215-00827.

To explore the prevalence risk factors of Beijing genotype Mycobacterium tuberculosis (MTB) in Beijing and its correlation with second-line anti tuberculosis drug resistance. A total of 1 140 clinical MTB positive strains were collected from various districts in Beijing, and the drug sensitivity was detected by proportion method. Beijing genotype and non Beijing genotype MTB were identified by the method of Spoligotyping. Using SPSS 22.0 statistical software, chi square test or Fisher exact probability test was used to analyze the experimental data. Among 1 140 MTB clinical isolates, 941 (82.5%) were Beijing genotype MTB, 199 were non Beijing genotype MTB. There were 663 males (70.5%) in Beijing genotype and 124 males (62.3%) in non Beijing genotype strains. There were significant differences in the proportion of males between the two genotypes [0.021, (95% ):1.442 (1.048-1.985)]. There were 441 floating population (46.9%) in Beijing genotype MTB and 78 floating population (39.2%) in non Beijing genotype MTB. There was a significant difference in the proportion of floating population between the two genotypes [0.048, (95):1.368(1.001-1.869)]. There were 129 patients (13.7%) aged 65 or older in Beijing genotype MTB, 40 patients (20.1%) aged 65 or older in non Beijing genotype MTB. The difference was statistically significant [0.021, or (95% ): 0.631 (0.426-0.936)]. The resistance drug rates of Levofloxacin (Lfx), Amikacin (Am), Capreomycin (Cm), Para-aminosalicylic (PAS) in Beijing genotypes were 5.5% (52/941), 1.3% (12/941), 3.2% (30/941) and 3.0% (28/941), respectively, and those of non Beijing genotypes were 10.6% (21/199), 8.5% (17/199, 12.6% (25/199) and 11.6% (23/199), the difference was statistically significant (all 0.05). There were 58 (6.2%) multidrug-resistant (MDR) strains in Beijing genotype MTB and 19 (9.5%) multidrug-resistant strains in non Beijing genotype. There was no significant difference in the proportion of MDR strains between Beijing genotype and non Beijing genotype (0.05). Beijing genotype MTB is widespread in Beijing and has a higher proportion in male population and floating population. Compared with non Beijing genotype, Beijing genotype MTB has a lower resistance rate to Lfx, Am, Cm and PAS, and there is no significant difference in the proportion of MDR-TB patients between the two genotypes.

探讨北京地区北京基因型结核分枝杆菌（MTB）的流行危险因素及其与二线抗结核药物耐药性的相关性。共收集北京各区县1140株临床MTB阳性菌株，采用比例法检测药物敏感性。采用Spoligotyping方法鉴定北京基因型和非北京基因型MTB。运用SPSS 22.0统计软件，采用卡方检验或Fisher确切概率法分析实验数据。在1140株MTB临床分离株中，941株（82.5%）为北京基因型MTB，199株为非北京基因型MTB。北京基因型菌株中有663例男性（70.5%），非北京基因型菌株中有124例男性（62.3%）。两种基因型的男性比例存在显著差异[P = 0.021，（95%CI）：1.442（1.048 - 1.985）]。北京基因型MTB中有441例流动人口（46.9%），非北京基因型MTB中有78例流动人口（39.2%）。两种基因型的流动人口比例存在显著差异[P = 0.048，（95%CI）：1.368（1.001 - 1.869）]。北京基因型MTB中65岁及以上患者有129例（13.7%），非北京基因型MTB中65岁及以上患者有40例（20.1%）。差异具有统计学意义[P = 0.021，OR（95%CI）：0.631（0.426 - 0.936）]。北京基因型中左氧氟沙星（Lfx）、阿米卡星（Am）、卷曲霉素（Cm）、对氨基水杨酸（PAS）的耐药率分别为5.5%（52/941）、1.3%（12/941）、3.2%（30/941）和3.0%（28/941），非北京基因型的耐药率分别为10.6%（21/199）、8.5%（17/199）、12.6%（25/199）和11.6%（23/199），差异具有统计学意义（均P < 0.05）。北京基因型MTB中有58株（6.2%）耐多药（MDR）菌株，非北京基因型中有19株（9.5%）耐多药菌株。北京基因型和非北京基因型的MDR菌株比例无显著差异（P > 0.05）。北京基因型MTB在北京地区广泛分布，在男性人群和流动人口中所占比例较高。与非北京基因型相比，北京基因型MTB对Lfx、Am、Cm和PAS的耐药率较低，两种基因型的耐多药结核病患者比例无显著差异。