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目的探讨L型结核分枝杆菌(MTB-L)及rpoB基因突变检测对复治肺结核诊断价值。方法对265例确诊肺结核患者痰标本进行MTB-L培养,其中初治肺结核143例,复治肺结核123例。对培养到的24例初治肺结核和52例复治肺结核患者MTB-L临床分离株进行药敏试验,并采用PCR和PCR-DS技术进行rpoB基因检测和序列分析。结果初治和复治肺结核MTB-L培养阳性率分别为16.78%(24/143)和42.28%(52/123),药敏结果提示初治和复治肺结核MTB-L对利福平耐药率分别为10.25%(3/24)和46.35%(24/52),28株L型结核分枝杆菌对利福平耐药,其中20株(71.4%)L型结核分枝杆菌rpoB基因发生突变。初治和复治肺结核MTB-L的rpoB基因突变率分别为为4.17%(1/24)和40.38%(21/52)。结论复治肺结核MTB-L检出率明显高于初治肺结核(P<0.05),复治肺结核MTB-L的rpoB基因突变率高于初治肺结核(P<0.05),L型结核菌及rpoB基因检测对复治肺结核诊断有较大价值。
Objective To investigate the diagnostic value of detection of Mycobacterium tuberculosis L (L-tuberculosis) and rpoB gene mutations in the diagnosis and treatment of pulmonary tuberculosis. Methods The sputum specimens of 265 confirmed cases of pulmonary tuberculosis were cultured in MTB-L, including 143 cases of primary tuberculosis and 123 cases of retreatment tuberculosis. MTB-L clinical isolates from 24 newly diagnosed pulmonary tuberculosis patients and 52 re-treatment pulmonary tuberculosis patients were tested for susceptibility. PCR and PCR-DS were used to detect and sequence the rpoB gene. Results The positive rates of MTB-L in newly diagnosed and retreated tuberculosis cases were 16.78% (24/143) and 42.28% (52/123), respectively. The results of susceptibility test showed that MTB-L was resistant to rifampicin 28 strains of Mycobacterium tuberculosis L were resistant to rifampicin, of which 20 (71.4%) were those of rpoB gene of Mycobacterium tuberculosis L, which were 10.25% (3/24) and 46.35% (24/52) mutation. The mutation rates of rpoB gene in MTB-L group were 4.17% (1/24) and 40.38% (21/52) respectively. Conclusions The detection rate of MTB-L in retreatment tuberculosis is significantly higher than that in newly diagnosed tuberculosis (P <0.05). The mutation rate of rpoB gene in retreatment tuberculosis MTB-L is higher than that in newly diagnosed tuberculosis (P <0.05) Genetic testing for the diagnosis and treatment of pulmonary tuberculosis have greater value.