Page 35 - 中国全科医学2022-29

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·论著·

糖尿病对肺结核菌株表型耐药及基因突变影响的

前瞻性研究

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张瑛梅 ，王飞 ，任小兵 ，王玥莲 ，陈俊 ，胡莹 ，胡晓勤 ，徐文革 1* 查看原文
【摘要】 背景 耐药结核病是当前结核防控难点，临床上肺结核合并糖尿病会增加结核病的控制难度，糖尿病
是否会影响肺结核菌株表型耐药，国内外研究并无统一定论。目的 探索糖尿病是否影响肺结核菌株表型耐药以及对
结核分枝杆菌耐药基因位点突变的影响。方法 选取 2018—2020 年在简阳市人民医院就诊的结核分枝杆菌培养阳性
肺结核患者 357 例，根据是否合并糖尿病，将其分为单纯肺结核组（PTB 组）216 例和合并糖尿病的肺结核组（DM-PTB
组）141 例。两组患者的晨痰标本进行表型药物敏感试验。PTB 组选择 62 例、DM-PTB 组选择 61 例进行结核分枝杆
菌耐药基因位点突变检测。结果 两组患者利福平、乙胺丁醇、链霉素耐药率比较，差异均无统计学意义（P>0.05）；
DM-PTB 组异烟肼耐药率高于 PTB 组（P<0.05）。两组患者异烟肼、利福平、链霉素单耐药率以及多耐药率比较，差
异均无统计学意义（P>0.05）；DM-PTB 组耐多药率高于 PTB 组（P<0.05）。两组患者检测基因位点突变率比较，差
异均无统计学意义（P>0.05）。结论 糖尿病会加重肺结核患者异烟肼耐药及耐多药情况，临床应该重视肺结核与糖
尿病的双向筛查。
【关键词】 结核，肺；糖尿病；结核，抗多种药物性；基因突变；表型耐药
【中图分类号】 R 521 R 587.1 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2022.0344
张瑛梅，王飞，任小兵，等 . 糖尿病对肺结核菌株表型耐药及基因突变影响的前瞻性研究［J］. 中国全科医学，
2022，25（29）：3616-3620. ［www.chinagp.net］
ZHANG Y M，WANG F，REN X B，et al. Phenotypic drug resistance and gene mutation in mycobacterium tuberculosis
with and without diabetes：a prospective study［J］. Chinese General Practice，2022，25（29）：3616-3620.

Phenotypic Drug Resistance and Gene Mutation in Mycobacterium Tuberculosis with and without Diabetes：
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a Prospective Study ZHANG Yingmei ，WANG Fei ，REN Xiaobing ，WANG Yuelian ，CHEN Jun ，HU Ying ，HU
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Xiaoqin ，XU Wenge 1*
1.The People's Hospital of Jianyang City，Jianyang 641401，China
2.Public Health Clinical Center of Chengdu，Chengdu 610000，China
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Corresponding author：XU Wenge，Associate chief physician，Associate professor；E-mail：985071476@qq.com
【Abstract】 Background It is difficult to prevent and control drug-resistant tuberculosis. The difficulty of containment
will be increased if tuberculosis is accompanied with diabetes. There is no clear conclusion on whether diabetes affects phenotypic
drug resistance in tuberculosis. Objective To assess the association of diabetes with phenotypic drug resistance and gene
mutation in mycobacterium tuberculosis. Methods A total of 357 culture-positive tuberculosis patients were recruited from the
People's Hospital of Jianyang City from 2018 to 2020，including 216 with pulmonary tuberculosis（PTB），and 141 with PTB
and diabetes（DM-PTB）. Early morning sputum samples were tested with drug sensitivity test for mycobacterium tuberculosis.
And 62 patients in the PTB group and 61 patients in the DM-PTB group were chosen to undergo test for mutations in drug
resistance genes. Results The resistance rates to rifampicin，ethambutol and streptomycin were similar in the two groups（P>0.05）.
Isoniazid resistance rate in DM-PTB group was significantly higher than that in PTB group（P<0.05），while there were no
significant intergroup differences in mono-drug resistance and ploy-drug resistance（P>0.05）. The multidrug resistance rate in
DM-PTB group was higher than that of PTB group（P<0.05）. And there was no significant difference in rate of mutation at the
gene loci between two groups（P>0.05）. Conclusion Diabetes will increase the rates of resistance to isoniazid and multidrugs
in tuberculosis patients. So attention should be given to the screening of both tuberculosis and diabetes.
【Key words】 Tuberculosis，pulmonary；Diabetes mellitus；Tuberculosis，multidrug-resistant；Genetic mutation；
Phenotypic drug resistance
基金项目：四川省科技厅面上项目（2018HH0058）；简阳市人民医院院内课题（JY201908）
1.641401 四川省简阳市人民医院 2.610000 四川省成都市公共卫生临床医疗中心
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通信作者：徐文革，副主任医师，副教授；E-mail：985071476@qq.com
本文数字出版日期：2022-07-21