喀什地区结核分枝杆菌基因型分布及其与肺结核患者临床特征的关联

doi:10.19982/j.issn.1000-6621.20240206

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (9): 1077-1082.doi: 10.19982/j.issn.1000-6621.20240206

喀什地区结核分枝杆菌基因型分布及其与肺结核患者临床特征的关联

帕里旦古丽·阿不都热合曼¹, 王森路², 古丽娜·巴德尔汗², 王乐², 祖力卡提阿衣·阿布都拉², 王新旗², 买吾拉江·依马木³, 王希江²()

¹新疆医科大学公共卫生学院,乌鲁木齐 830054
²新疆维吾尔自治区疾病预防控制中心,乌鲁木齐 830002
³新疆喀什地区疾控预防控制中心,喀什 844000

收稿日期:2024-05-25 出版日期:2024-09-10 发布日期:2024-08-30
通信作者: 王希江,Email:2500681917@qq.com
基金资助:
新疆维吾尔自治区重点研发专项(2021B03003-1);喀什地区科技局课题(KS2020018)

Distribution of Mycobacterium tuberculosis genotypes in Kashgar region and their association with clinical characteristics of pulmonary tuberculosis patients

Palidanguli Abudureheman¹, Wang Senlu², Gulina Badeerhan², Wang Le², Zulikatiayi Abudula², Wang Xinqi², Maiwulajiang Yimamu³, Wang Xijiang²()

¹School of public Health, Xinjiang Medical University, Urumqi 830054, China
²Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi 830002, China
³Disease Control and Prevention Center in Kashgar, Xinjiang Uygur Autonomous Region, Kashgar 844000, China

Received:2024-05-25 Online:2024-09-10 Published:2024-08-30
Contact: Wang Xijiang, Email:2500681917@qq.com
Supported by:
Major Science and Technology Project of Xinjiang Uygur Autonomous Region(2021B03003-1);Project of Kashgar Science and Technology Bureau(KS2020018)

摘要/Abstract

摘要：

目的: 了解喀什地区结核分枝杆菌(Mycobacterium tuberculosis,MTB)基因型分布情况,以及基因分型与肺结核患者临床特征之间的关联。方法: 收集2020年喀什地区结核病定点医院临床分离的MTB菌株,将其中有完整病例信息的810例肺结核患者和其对应的810株MTB临床分离株纳入研究。肺结核患者的个案信息从“结核病管理信息系统”中调取,包括患者的姓名、性别、年龄、职业等基本信息和临床症状、影像学表现、治疗史、治疗方案、治疗结局等。采用Illuminate HiSeq二代测序平台对MTB菌株进行基因分型,并鉴定谱系。结果: 810株MTB中Lineage2谱系292株(36.0%)、Lineage3谱系321株(39.6%)、Lineage4谱系197株(24.4%)。喀什市、疏附县、疏勒县等县、市的MTB的谱系分布不均;有效测得的572株亚谱系中Lineage2.2.1亚谱系占44.6%(255/572)、Lineage2.2.2亚谱系占6.8%(39/572); Lineage3.1.3亚谱系占14.9%(85/572);Lineage4谱系分化较广,即Lineage4.1~4.9,其中Lineage4.5亚谱系占29.9%(171/572)。菌株谱系与患者临床症状之间差异不明显;相较其他谱系,Lineage3谱系菌株感染者痰涂片阳性比例更低(27.7%,89/321),但明确治愈者的比例更高(37.1%,119/321),差异均有统计学意义(χ²值分别为6.192和24.558,P值均<0.05)。结论: 喀什地区MTB谱系、亚谱系分布呈基因多态性,Lineage3谱系感染患者涂片阳性率较低,临床治愈率较高。

关键词: 分枝杆菌,结核, 基因组,细菌, 多态性,单核苷酸, 疾病特征

Abstract:

Objective: To investigate the distribution of Mycobacterium tuberculosis (MTB) genotypes in the Kashgar region and to analyze the correlation between these genotypes and the clinical characteristics of pulmonary tuberculosis patients. Methods: MTB strains were collected from tuberculosis-designated hospitals in Kashgar in 2020. The study included 810 tuberculosis patients with complete case information and their corresponding 810 MTB clinical isolates. Case information for the pulmonary tuberculosis patients was retrieved from the “Tuberculosis Management Information System” encompassing the patient’s name, gender, age, occupation, clinical symptoms, imaging findings, treatment history, treatment plan, and treatment outcome. MTB strains were genotyped and their lineages identified using the Illumina HiSeq second-generation sequencing platform. Results: Among the 810 MTB strains, 292 strains (36.0%) belonged to Lineage2, 321 strains (39.6%) belonged to Lineage3, and 197 strains (24.4%) belonged to Lineage4. The distribution of MTB lineages varied across different counties and cities, including Kashgar, Shufu County, and Shule County. Among the 572 effectively measured sublineages, Lineage 2.2.1 accounted for 44.6% (255/572) and Lineage2.2.2 accounted for 6.8% (39/572); the Lineage3.1.3 sublineage accounted for 14.9% (85/572). Lineage4 showed a wide differentiation into sublineages, namely Lineage4.1 to Lineage4.9, with the Lineage4.5 sublineage comprising 29.9% (171/572). There was no significant difference between the strain lineage and the clinical symptoms of the patients. However, compared with other lineages, individuals infected with Lineage3 strains had a lower proportion of sputum smear positivity (27.7%, 89/321) and a higher proportion of clear cure (37.1%, 119/321). These differences were statistically significant (χ² values were 6.192 and 24.558, respectively, with P values <0.05). Conclusion: The distribution of MTB lineages and sublineages in the Kashgar region demonstrates genetic polymorphism. Lineage3 infections are associated with a low sputum smear positivity rate and a high clinical cure rate.

Key words: Mycobacterium tuberculosis, Bacterial genome, Single nucleotide polymorphism, Disease characteristics

中图分类号:

帕里旦古丽·阿不都热合曼, 王森路, 古丽娜·巴德尔汗, 王乐, 祖力卡提阿衣·阿布都拉, 王新旗, 买吾拉江·依马木, 王希江. 喀什地区结核分枝杆菌基因型分布及其与肺结核患者临床特征的关联[J]. 中国防痨杂志, 2024, 46(9): 1077-1082. doi: 10.19982/j.issn.1000-6621.20240206

Palidanguli Abudureheman, Wang Senlu, Gulina Badeerhan, Wang Le, Zulikatiayi Abudula, Wang Xinqi, Maiwulajiang Yimamu, Wang Xijiang. Distribution of Mycobacterium tuberculosis genotypes in Kashgar region and their association with clinical characteristics of pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2024, 46(9): 1077-1082. doi: 10.19982/j.issn.1000-6621.20240206

图/表 3

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特征	患者数 (例)	构成比/发生率 (%)
性别
男性	386	47.7
女性	424	52.3
年龄组(岁)
<20	25	3.1
20~39	135	16.7
40~59	167	20.6
≥60	483	59.6
临床症状
咳嗽、咳痰≥2周	686	84.7
咳嗽、咳痰<2周	97	12.0
咯血或咳痰	13	1.6
发热	43	5.3
胸痛	29	3.6
体质量下降	21	2.6
盗汗	114	14.1
影像学检查
空洞	112	13.8
粟粒	4	0.5
普通病变	604	85.7
痰涂片结果
阳性	235	29.0
阴性	575	71.0
结核分枝杆菌谱系
Lineage2	292	36.0
Lineage3	321	39.6
Lineage4	197	24.4
治疗分类
初治	649	80.1
复治	161	19.9
合计	810	100.0

临床特征	Lineage2谱系 (292例)	Lineage3谱系 (321例)	Lineage4谱系 (197例)	χ²值	P值
临床症状[例(发生率,%)]
咳嗽、咳痰	268(91.7)	297(92.5)	187(95.0)	1.828	0.413
咯血	4(1.3)	7(2.2)	2(1.0)	1.210	0.546
发热	15(5.1)	13(4.0)	15(7.6)	3.112	0.211
胸痛	10(3.4)	9(2.8)	10(5.1)	1.858	0.395
空洞[例(构成比,%)]				0.829	0.661
有	44(15.1)	44(13.7)	24(12.2)
无	248(84.9)	277(86.3)	173(87.8)
痰涂片结果[例(构成比,%)]				6.192	0.045
阳性	99(33.9)	89(27.7)	47(23.9)
阴性	193(66.1)	232(72.3)	150(76.1)
治疗分类[例(构成比,%)]				5.088	0.079
初治	239(81.8)	245(76.3)	165(83.8)
复治	53(18.2)	76(23.7)	32(16.2)
治疗结局[例(构成比,%)]				24.558	0.000
明确治愈	69(23.6)	119(37.1)	36(18.3)
结局不明	223(76.4)	202(62.9)	161(81.7)

喀什地区结核分枝杆菌基因型分布及其与肺结核患者临床特征的关联

Distribution of Mycobacterium tuberculosis genotypes in Kashgar region and their association with clinical characteristics of pulmonary tuberculosis patients

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亚谱系名	巴楚	伽师	喀什市	麦盖提	莎车	疏附	疏勒	叶城	英吉沙	岳普湖	泽普
Lineage2.2.1	38	31	8	38	88	8	1	1	30	0	12
Lineage2.2.2	7	3	0	9	18	0	0	0	1	0	1
Lineage3.1.3	7	13	3	17	22	4	0	6	5	7	1
Lineage4.1	2	0	0	0	3	0	0	0	1	0	0
Lineage4.2	0	1	0	1	5	0	0	0	0	0	0
Lineage4.4	0	0	0	0	1	0	0	0	0	0	0
Lineage4.5	21	37	4	16	61	2	3	0	22	0	5
Lineage4.6	0	0	1	0	0	0	0	0	0	0	0
Lineage4.7	0	1	0	0	0	0	0	0	0	0	0
Lineage4.8	0	1	3	0	1	0	0	0	0	0	0
Lineage4.9	0	1	0	0	0	0	0	0	0	0	0

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