高分辨率熔解分析确定结核分枝杆菌感染和利福平及异烟肼耐药的区域分布。
Regional distribution of Mycobacterium tuberculosis infection and resistance to rifampicin and isoniazid as determined by high-resolution melt analysis.
机构信息
The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, 471000, Luo Yang, China.
School of Medical Technology and Engineering, Henan University of Science and Technology, Luo Yang, 471000, China.
出版信息
BMC Infect Dis. 2022 Oct 31;22(1):812. doi: 10.1186/s12879-022-07792-7.
BACKGROUND
Identifying the transmission mode and resistance mechanism of Mycobacterium tuberculosis (MTB) is key to prevent disease transmission. However, there is a lack of regional data. Therefore, the aim of this study was to identify risk factors associated with the transmission of MTB and regional patterns of resistance to isoniazid (INH) and rifampicin (RFP), as well as the prevalence of multidrug-resistant tuberculosis (MDR-TB).
METHODS
High-resolution melt (HRM) analysis was conducted using sputum, alveolar lavage fluid, and pleural fluid samples collected from 17,515 patients with suspected or confirmed MTB infection in the downtown area and nine counties of Luoyang City from 2019 to 2021.
RESULTS
Of the 17,515 patients, 82.6% resided in rural areas, and 96.0% appeared for an initial screening. The HRM positivity rate was 16.8%, with a higher rate in males than females (18.0% vs. 14.1%, p < 0.001). As expected, a positive sputum smear was correlated with a positive result for HRM analysis. By age, the highest rates of MTB infection occurred in males (22.9%) aged 26-30 years and females (28.1%) aged 21-25. The rates of resistance to RFP and INH and the incidence of MDR were higher in males than females (20.5% vs. 16.1%, p < 0.001, 15.9% vs. 12.0%, p < 0.001 and 12.9% vs. 10.2%, p < 0.001, respectively). The HRM positivity rate was much higher in previously treated patients than those newly diagnosed for MTB infection. Notably, males at the initial screening had significantly higher rates of HRM positive, INH resistance, RFP resistance, and MDR-TB than females (all, p < 0.05), but not those previously treated for MTB infection. The HRM positivity and drug resistance rates were much higher in the urban vs. rural population. By multivariate analyses, previous treatment, age < 51 years, residing in an urban area, and male sex were significantly and positively associated with drug resistance after adjusting for smear results and year of testing.
CONCLUSION
Males were at higher risks for MTB infection and drug resistance, while a younger age was associated with MTB infection, resistance to INH and RFP, and MDR-TB. Further comprehensive monitoring of resistance patterns is needed to control the spread of MTB infection and manage drug resistance locally.
背景
鉴定结核分枝杆菌（MTB）的传播模式和耐药机制是预防疾病传播的关键。然而，目前缺乏区域性数据。因此，本研究的目的是确定与 MTB 传播相关的危险因素以及区域异烟肼（INH）和利福平（RFP）耐药模式，以及耐多药结核病（MDR-TB）的流行情况。
方法
使用高分辨率熔解（HRM）分析对 2019 年至 2021 年在洛阳市市区和 9 个县的 17515 例疑似或确诊 MTB 感染患者的痰、肺泡灌洗液和胸腔液样本进行检测。
结果
17515 例患者中，82.6%居住在农村，96.0%进行了初步筛查。HRM 阳性率为 16.8%，男性阳性率高于女性（18.0%比 14.1%，p<0.001）。与预期一致的是，痰涂片阳性与 HRM 分析结果阳性相关。按年龄划分，26-30 岁男性（22.9%）和 21-25 岁女性（28.1%）的 MTB 感染率最高。男性对 RFP 和 INH 的耐药率以及 MDR 的发生率均高于女性（20.5%比 16.1%，p<0.001，15.9%比 12.0%，p<0.001 和 12.9%比 10.2%，p<0.001）。与新诊断的 MTB 感染患者相比，既往治疗过的患者的 HRM 阳性率更高。值得注意的是，在初筛时，男性的 HRM 阳性、INH 耐药、RFP 耐药和 MDR-TB 发生率均显著高于女性（均 p<0.05），但在既往治疗过的 MTB 感染患者中则不然。与农村地区相比，城市地区的 HRM 阳性率和药物耐药率更高。多变量分析结果显示，在校正涂片结果和检测年份后，既往治疗、年龄<51 岁、居住在城市地区和男性与药物耐药显著正相关。
结论
男性患 MTB 感染和耐药的风险更高，而年龄较小与 MTB 感染、对 INH 和 RFP 的耐药以及 MDR-TB 相关。需要进一步全面监测耐药模式，以控制 MTB 感染的传播并在当地管理耐药性。
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