中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (2): 129-137.doi: 10.3969/j.issn.1000-6621.2019.02.003
所属专题: GeneXpert MTB/RIF检测技术相关研究; 标准、共识、指南
《中国防痨杂志》编辑委员会中国医疗保健国际交流促进会结核病防治分会基础学组和临床学组
收稿日期:
2019-01-03
出版日期:
2019-02-10
发布日期:
2019-02-01
Editorial Board of Chinese Journal of Antituberculosis,Basic and Clinical Groups of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care
Received:
2019-01-03
Online:
2019-02-10
Published:
2019-02-01
摘要:
耐药结核病尤其是耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)是目前临床亟待解决的难题之一,而对抗结核药物进行药物敏感性试验(DST)可为耐药结核病的诊断提供实验室依据。本专家共识简要地介绍了我国临床常用的结核分枝杆菌(MTB)DST方法(包括表型DST和分子DST);提出了MTB耐药性检测策略和正确判读检测结果的建议;指出目前DST检测技术和临床应用存在的问题,并对未来DST的发展前景进行了展望。
《中国防痨杂志》编辑委员会中国医疗保健国际交流促进会结核病防治分会基础学组和临床学组. 结核分枝杆菌耐药性检测专家共识[J]. 中国防痨杂志, 2019, 41(2): 129-137. doi: 10.3969/j.issn.1000-6621.2019.02.003
Editorial Board of Chinese Journal of Antituberculosis,Basic and Clinical Groups of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care. Expert consensus on detection of Mycobacterium tuberculosis drug resistance[J]. Chinese Journal of Antituberculosis, 2019, 41(2): 129-137. doi: 10.3969/j.issn.1000-6621.2019.02.003
表1
分子DST检测MTB对常见抗结核药物的耐药基因及突变位点
抗结核 药物 | 检测的 靶基因 | 编码的产物 | 靶区域,突变率 | 常检测的突变位点, 发生率及耐药水平 |
---|---|---|---|---|
RFP、Rft和Rfb | rpoβ | RNA聚合酶β亚单位 | 507~533位密码子(81bp),90%~95% | 531、526位密码子,30%~75%,高 |
INH | katG | 过氧化氢酶-过氧化物酶 | 整个基因,60%~95% | 315位密码子,70%~80%,低 |
inhA | 烯酰基运载蛋白还原酶 | 调节区,12% | -15,10%,低 | |
EMB | embB | 阿拉伯糖基转移酶 | 整个基因,36%~70.6% | 306位密码子,47%~89%,高 |
Sm | rpsL | 核糖体蛋白S12 | 43和88位密码子,40%~95% | K43R,40%~90%,高 |
rrs | 16S rRNA | 整个基因碱基,29% | 513位,10.3%,低 | |
PZA | pncA | 吡嗪酰胺酶 | 编码基因(约占97%)和启动子(约占3%),68%~97% | 3~17、61~85和132~142位密码子,高 |
FQs | gyrA | DNA旋转酶A | 67~106位密码子,75%~94% | D94N或H或G或Y或A、A90V、G88C、W91P和A83V;D94G,21%~32%,高; A90V,13%~20%,低 |
gyrB | DNA旋转酶B | 5%~15% | T511N、P592S;N538D、E540V 和R485C+T539N,低 | |
Am、Km和Cm | rrs | 16S rRNA | 50%~84% | A1401G,60%~84%耐Km菌株、50%~80%耐Am或Cm菌株 |
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