| Objective:To understand the drug resistance of Mycobacterium tuberculosis in Hunan area bytuberculosis drug sensitivity test, and to establish the drug resistant spectrum; Analysis of conventional drug susceptibility of rifampicin and isoniazid and their resistance related gene and comparing the coincidence rate of the both; Through the detection of distribution of drug resistance gene mutations, we could get the baseline information of the prevalence of tuberculosis in Hunan region and provide reference for effective prevention and control of tuberculosis.Methods:2331 patients who diagnosed tuberculosis in the Changsha Central Hospital were collected between January 1, 2013 and September 30, 2014. absolute concentration method which including nine kinds of drug such as isoniazid, streptomycin, ethambutol, isoniazid, amino acid, card that mildew element, ethionamide, pyrazinamide and ofloxacin were used. 1031 samples were selected to use gene chip technique for the detection of rpoB, katG and inhA gene mutation in RFP and INH resistance in order to evaluate the value of gene chip technology in clinic.Results :1.The prevalence of drug resistance in Hunan:(1)Among the 2331 cases, 1678 cases were cured, accounting for 71.99% of all strains; 653 cases were treated, and the proportion was 28.01%. Total drug resistance rate was 22.52%(525/2331). In all patients the primary treatment resistant rate was 15.20%(255/1678) and retreatment of drug-resistant rate was 41.35%(270/653,χ2=223.1,P<0.05), retreatment resistant patients were higher than that of patients with primary treatment, the difference has statistical significance.(2)Multi drug resistant rate was 8.11%(189/2331), in which the initial treatment multi drug resistant rate was 3.87%(65/1678) and the retreatment multi drug resistant rate was 18.99%(124/653,χ2 =519.8,P<0.05). Retreatment patients who resistant to multiple drug were higher than that of patients with primary treatment, and the difference has statistical significance.(3)The drug resistance of any anti-TB from high to low was INH, RFP, SM, EMB, LFX, PZA, PAS, ETO, KM. And INH drug resistance rate was 14.16%, which was the highest among them.(4)It had 6 cases of XDR-TB in this study, which drug resistance rate was 0.26%(6/2331), including one case of primary treatment.2. Comparison of chip method and absolute concentration method:(1)The result of RFP resistant strains microarray detection had 1011 casesin line with the absolute concentration method,the coincidence rate of these two methods was 98.06%.(2)The result of INH resistant strains microarray detection had 1005 casesin line with the absolute concentration method,the coincidence rate of these two methods was 97.48%.(3)The most common mutation site was 531 TCG→TTG in RFP rpoBresistant gene mutations, it had 69 cases which accounted for mutant strain of 51.1%(69/135). The second common mutation site was 526CAC→TAC, it had 14 cases which accounted for mutant strain of 10.4%(14/135). A total of 11 CAC→GAC were mutated, accounting for 8.15% of the mutant strain(11/135).INH resistance was mainly by katG315 mutations, mutations account for strain 88.5%(115/130) and only 11.5%(15/130) was due to InhA mutations.Conclusion:1.The prevalence of tuberculosis drug resistance and MDR-TB in Hunan is in the low level of the whole country, but the drug resistance is still not optimistic and need priority on this problem.2. The research shows that the 9 antituberculous drugs have a certain degree of resistance in Hunan area,the drug resistance of any anti-TB from high to low was INH, RFP, SM, EMB, LFX, PZA, PAS, ETO, KM. And INH drug resistance rate was 14.16%, which was the highest among them.3.The results of gene chip detection technology were highly consistent with absolute concentration methods and the chip can become effective method to rapid screening RFP and INH resistance in Hunan area.4.The principal Mutation sites of RFP and INH in Mycobacterium tuberculosis were rpoB531, 526 and katG315 in Hunan area. |
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