Article(id=1241035547834110306, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408442, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1724860800000, receivedDateStr=2024-08-29, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815531929, onlineDateStr=2026-03-18, pubDate=1735056000000, pubDateStr=2024-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815531929, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815531929, creator=13701087609, updateTime=1773815531929, updator=13701087609, issue=Issue{id=1241035543589483182, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815530917, creator=13701087609, updateTime=1773815686426, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036195896029478, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036195896029479, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4555, endPage=4560, ext={EN=ArticleExt(id=1241035548333232498, articleId=1241035547834110306, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Drug resistance of Rifumpicin and genotype analysis of Mycobacterium tuberculosis in Ningxia, 2020-2023, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the rifampicin resistance, genotypic characteristics and clustering of Mycobacterium tuberculosis in Ningxia from 2020-2023.

Methods

98 strains of Mycobacterium tuberculosis were tested for rifampicin resistance using the GeneXpert MTB/RIF method, and the strains were genotyped by the McSpoligotyping method and analyzed by clustering at the MIRU-VNTRplus website.

Results

The risk of developing rifampicin-resistant TB was significantly increased in retreatment patients (OR=33.22, 95% CI: 3.11-355.43, P<0.05), and TB patients from Zhongwei and Wuzhong cities showed a higher risk of rifampicin resistance (OR=19.42, 95% CI: 1.12-336.75, P<0.05; OR=43.25, 95% CI: 1.76-1062.70, P<0.05). 98 strains of Mycobacterium tuberculosis were typed by McSpoligotyping to present three lineages, with the largest lineage being the Beijing-type 80 strains (81.63%); the non-Beijing-type accounted for 18 strains (18.37%), of which 12 strains were of the T-type (12.24%), 1 strain of the U-type (1.02%), and the newly 5 strains (5.10%) were newly discovered or undefined genotypes. The Beijing type was widely distributed in all cities of Ningxia, with only the Beijing type in Guyuan and Shizuishan, and the T-type and newly discovered or undefined genotypes were mostly found in Zhongwei, Wuzhong and Yinchuan. Cluster analysis showed that the 98 strains were divided into two genetic clusters, Beijing-type and non-Beijing-type, with SIT1 accounting for the largest proportion of Beijing-type in the clusters (75.51%), T1-type in the non-Beijing-type, and the remaining 9 strains (9.18%) were independent scattered genotypes, with a cluster rate of 90.82% (89/98).

Conclusion

Health education has been actively carried out for retreatment patients and high-risk areas in the Ningxia region to improve treatment adherence, and TB screening and drug resistance surveillance has been strengthened in Zhongwei and Wuzhong cities. In addition, Mycobacterium tuberculosis is genetically polymorphic in this region, and Beijing SIT 1 is the main prevalent strain. Strengthening the monitoring of this gene and understanding its mode of transmission is important for controlling the spread of tuberculosis, slowing down the development of drug resistance, and ultimately improving the public health situation in the region.

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目的

研究2020—2023年宁夏地区结核分枝杆菌利福平耐药性、基因型特征及聚类情况。

方法

采用GeneXpert MTB/RIF法对98株结核分枝杆菌进行利福平耐药检测,McSpoligotyping方法对菌株进行基因分型并在MIRU-VNTRplus网站进行聚类分析。

结果

复治患者发展为利福平耐药肺结核的风险显著增加(OR=33.22,95% CI:3.11~355.43,P<0.05),来自中卫市和吴忠市的肺结核患者表现出较高的利福平耐药风险(OR=19.42,95% CI:1.12~336.75,P<0.05;OR=43.25,95% CI:1.76~1062.70,P<0.05)。98株结核分枝杆菌经McSpoligotyping分型呈现出3种家系,最大的家系为北京型80株(81.63%);非北京型占18株(18.37%),其中T型12株(12.24%),U型1株(1.02%),新发现或未定义基因型5株(5.10%)。北京型广泛分布于宁夏各市,固原市与石嘴山市仅为北京型,T型与新发现或未定义基因型多见于中卫市、吴忠市、银川市。聚类分析显示98株菌株分为北京型、非北京型两个基因聚类,成簇的北京型中SIT1占比最大(75.51%),非北京型中T1型最多,其余9株(9.18%)为独立的散在基因型,成簇率为90.82%(89/98)。

结论

针对宁夏地区复治患者和高风险地区积极开展健康教育,提高治疗依从性,加强中卫市和吴忠市的结核病筛查及耐药性监测工作。此外,该地区结核分枝杆菌具有基因多态性,北京型SIT 1为主要的流行株,加强该基因的监测,了解其传播模式可有效控制结核病的传播、减缓耐药性发展,最终改善当地公共卫生状况具有重要意义。

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魏建华,E-mail:
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吕菊芬(1999—),女,硕士在读,研究方向:传染性疾病流行病学研究

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注:圆形图标为MTB基因型,每个圆形代表不同的基因型,括号里数字代表该基因型的菌株数,括号前表示基因型及其国际型别编号。红色代表北京SIT 1型有74株;蓝色分别代表北京SIT 190型有3株菌株、非北京SIT 53有5株;紫色代表非北京SIT 334型有2株菌株;白色代表对应基因型只有1株菌株;虚线上的数字为不同基因型之间有多少个间隔区存在差异。

, figureFileSmall=Vx8ow1EnoxVlwxDtIHVAKQ==, figureFileBig=cqboNdAfT0P6xSLtLqWZ/A==, tableContent=null), ArticleFig(id=1241069995959055210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=EN, label=Table 1, caption=

Analysis of drug resistance to rifapin in patients with tuberculosis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数(例)敏感(%)耐药(%)χ2P
年龄(岁)5.8220.170
0~1921(1.23)1(7.69)
20~392523(28.40)2(15.39)
40~592620(24.69)6(46.15)
60~793532(39.51)3(23.08)
80~65(6.17)1(7.69)
性别4.2350.040
5544(54.32)11(84.62)
3937(45.68)2(15.38)
职业4.6750.179
机关企事业人员118(9.88)3(23.08)
农林牧业人员5044(54.32)6(46.15)
学生21(1.23)1(7.69)
其他3128(34.57)3(23.08)
治疗史22.132<0.001
初治8679(97.53)7(53.85)
复治82(2.47)6(46.15)
民族0.1660.684
汉族5952(64.20)7(53.85)
回族3529(35.80)6(46.15)
基因型别0.3210.571
北京型7866(81.48)12(92.31)
非北京型1615(18.52)1(7.69)
地区10.1230.019
银川市4039(48.15)1(7.70)
中卫市2117(20.99)4(30.77)
吴忠市1410(12.35)4(30.77)
固原市1210(12.35)2(15.38)
石嘴山市75(6.17)2(15.38)
), ArticleFig(id=1241069996076495727, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=CN, label=表1, caption=

肺结核患者对利福平的耐药性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数(例)敏感(%)耐药(%)χ2P
年龄(岁)5.8220.170
0~1921(1.23)1(7.69)
20~392523(28.40)2(15.39)
40~592620(24.69)6(46.15)
60~793532(39.51)3(23.08)
80~65(6.17)1(7.69)
性别4.2350.040
5544(54.32)11(84.62)
3937(45.68)2(15.38)
职业4.6750.179
机关企事业人员118(9.88)3(23.08)
农林牧业人员5044(54.32)6(46.15)
学生21(1.23)1(7.69)
其他3128(34.57)3(23.08)
治疗史22.132<0.001
初治8679(97.53)7(53.85)
复治82(2.47)6(46.15)
民族0.1660.684
汉族5952(64.20)7(53.85)
回族3529(35.80)6(46.15)
基因型别0.3210.571
北京型7866(81.48)12(92.31)
非北京型1615(18.52)1(7.69)
地区10.1230.019
银川市4039(48.15)1(7.70)
中卫市2117(20.99)4(30.77)
吴忠市1410(12.35)4(30.77)
固原市1210(12.35)2(15.38)
石嘴山市75(6.17)2(15.38)
), ArticleFig(id=1241069996206519157, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=EN, label=Table 2, caption=

Distribution of genotypes of 98 strains of Mycobacterium tuberculosis in Ningxia

, figureFileSmall=null, figureFileBig=null, tableContent=
基因型别SITSpoligotype株数(株)占比(%)
Beijing17475.51
19033.06
26511.02
62111.02
2 97911.02
T1711.02
5355.10
33422.04
2 90511.02
3 22811.02
T284811.02
T33711.02
Ural-23 10911.02
Orphan/New-11.02
-11.02
-11.02
-11.02
-11.02
合计9899.99
), ArticleFig(id=1241069996298793849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=CN, label=表2, caption=

宁夏地区98株结核分枝杆菌基因型分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
基因型别SITSpoligotype株数(株)占比(%)
Beijing17475.51
19033.06
26511.02
62111.02
2 97911.02
T1711.02
5355.10
33422.04
2 90511.02
3 22811.02
T284811.02
T33711.02
Ural-23 10911.02
Orphan/New-11.02
-11.02
-11.02
-11.02
-11.02
合计9899.99
), ArticleFig(id=1241069996449788800, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=EN, label=Table 3, caption=

Distribution and genotype distribution of Mycobacterium tuberculosisn(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
地区BeijingTUNew合计
石嘴山市7(100.00)0(0.00)0(0.00)0(0.00)7(100.00)
银川市36(83.72)4(9.30)0(0.00)3(6.98)43(100.00)
吴忠市9(64.29)3(21.43)1(7.14)1(7.14)14(100.00)
中卫市16(72.73)5(22.73)0(0.00)1(4.54)22(100.00)
固原市12(100.00)0(0.00)0(0.00)0(0.00)12(100.00)
), ArticleFig(id=1241069996575617926, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035547834110306, language=CN, label=表3, caption=

结核分枝杆菌菌株分布及基因型别分布情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
地区BeijingTUNew合计
石嘴山市7(100.00)0(0.00)0(0.00)0(0.00)7(100.00)
银川市36(83.72)4(9.30)0(0.00)3(6.98)43(100.00)
吴忠市9(64.29)3(21.43)1(7.14)1(7.14)14(100.00)
中卫市16(72.73)5(22.73)0(0.00)1(4.54)22(100.00)
固原市12(100.00)0(0.00)0(0.00)0(0.00)12(100.00)
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2020—2023年宁夏地区结核分枝杆菌利福平耐药性及基因型分析
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吕菊芬 1, 2 , 刘广天 3 , 温静 1, 2 , 魏建华 3
现代预防医学 | 实验技术及其应用 2024,51(24): 4555-4560
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现代预防医学 | 实验技术及其应用 2024, 51(24): 4555-4560
2020—2023年宁夏地区结核分枝杆菌利福平耐药性及基因型分析
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吕菊芬1, 2, 刘广天3, 温静1, 2, 魏建华3
作者信息
  • 1.宁夏医科大学公共卫生学院,宁夏 银川 750004
  • 2.宁夏回族自治区环境因素与慢性病控制重点实验室
  • 3.宁夏回族自治区第四人民医院
  • 吕菊芬(1999—),女,硕士在读,研究方向:传染性疾病流行病学研究

通讯作者:

魏建华,E-mail:
Drug resistance of Rifumpicin and genotype analysis of Mycobacterium tuberculosis in Ningxia, 2020-2023
Ju-fen LV1, 2, Guang-tian LIU3, Jing WEN1, 2, Jian-hua WEI3
Affiliations
  • School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
出版时间: 2024-12-25 doi: 10.20043/j.cnki.MPM.202408442
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目的

研究2020—2023年宁夏地区结核分枝杆菌利福平耐药性、基因型特征及聚类情况。

方法

采用GeneXpert MTB/RIF法对98株结核分枝杆菌进行利福平耐药检测,McSpoligotyping方法对菌株进行基因分型并在MIRU-VNTRplus网站进行聚类分析。

结果

复治患者发展为利福平耐药肺结核的风险显著增加(OR=33.22,95% CI:3.11~355.43,P<0.05),来自中卫市和吴忠市的肺结核患者表现出较高的利福平耐药风险(OR=19.42,95% CI:1.12~336.75,P<0.05;OR=43.25,95% CI:1.76~1062.70,P<0.05)。98株结核分枝杆菌经McSpoligotyping分型呈现出3种家系,最大的家系为北京型80株(81.63%);非北京型占18株(18.37%),其中T型12株(12.24%),U型1株(1.02%),新发现或未定义基因型5株(5.10%)。北京型广泛分布于宁夏各市,固原市与石嘴山市仅为北京型,T型与新发现或未定义基因型多见于中卫市、吴忠市、银川市。聚类分析显示98株菌株分为北京型、非北京型两个基因聚类,成簇的北京型中SIT1占比最大(75.51%),非北京型中T1型最多,其余9株(9.18%)为独立的散在基因型,成簇率为90.82%(89/98)。

结论

针对宁夏地区复治患者和高风险地区积极开展健康教育,提高治疗依从性,加强中卫市和吴忠市的结核病筛查及耐药性监测工作。此外,该地区结核分枝杆菌具有基因多态性,北京型SIT 1为主要的流行株,加强该基因的监测,了解其传播模式可有效控制结核病的传播、减缓耐药性发展,最终改善当地公共卫生状况具有重要意义。

结核病  /  结核分枝杆菌  /  利福平耐药  /  基因分型技术  /  分子流行病学
Objective

To study the rifampicin resistance, genotypic characteristics and clustering of Mycobacterium tuberculosis in Ningxia from 2020-2023.

Methods

98 strains of Mycobacterium tuberculosis were tested for rifampicin resistance using the GeneXpert MTB/RIF method, and the strains were genotyped by the McSpoligotyping method and analyzed by clustering at the MIRU-VNTRplus website.

Results

The risk of developing rifampicin-resistant TB was significantly increased in retreatment patients (OR=33.22, 95% CI: 3.11-355.43, P<0.05), and TB patients from Zhongwei and Wuzhong cities showed a higher risk of rifampicin resistance (OR=19.42, 95% CI: 1.12-336.75, P<0.05; OR=43.25, 95% CI: 1.76-1062.70, P<0.05). 98 strains of Mycobacterium tuberculosis were typed by McSpoligotyping to present three lineages, with the largest lineage being the Beijing-type 80 strains (81.63%); the non-Beijing-type accounted for 18 strains (18.37%), of which 12 strains were of the T-type (12.24%), 1 strain of the U-type (1.02%), and the newly 5 strains (5.10%) were newly discovered or undefined genotypes. The Beijing type was widely distributed in all cities of Ningxia, with only the Beijing type in Guyuan and Shizuishan, and the T-type and newly discovered or undefined genotypes were mostly found in Zhongwei, Wuzhong and Yinchuan. Cluster analysis showed that the 98 strains were divided into two genetic clusters, Beijing-type and non-Beijing-type, with SIT1 accounting for the largest proportion of Beijing-type in the clusters (75.51%), T1-type in the non-Beijing-type, and the remaining 9 strains (9.18%) were independent scattered genotypes, with a cluster rate of 90.82% (89/98).

Conclusion

Health education has been actively carried out for retreatment patients and high-risk areas in the Ningxia region to improve treatment adherence, and TB screening and drug resistance surveillance has been strengthened in Zhongwei and Wuzhong cities. In addition, Mycobacterium tuberculosis is genetically polymorphic in this region, and Beijing SIT 1 is the main prevalent strain. Strengthening the monitoring of this gene and understanding its mode of transmission is important for controlling the spread of tuberculosis, slowing down the development of drug resistance, and ultimately improving the public health situation in the region.

Tuberculosis  /  Mycobacterium tuberculosis  /  Rifampicin resistance  /  Genotyping technology  /  Molecular epidemiology
吕菊芬, 刘广天, 温静, 魏建华. 2020—2023年宁夏地区结核分枝杆菌利福平耐药性及基因型分析. 现代预防医学, 2024 , 51 (24) : 4555 -4560 . DOI: 10.20043/j.cnki.MPM.202408442
Ju-fen LV, Guang-tian LIU, Jing WEN, Jian-hua WEI. Drug resistance of Rifumpicin and genotype analysis of Mycobacterium tuberculosis in Ningxia, 2020-2023[J]. Modern Preventive Medicine, 2024 , 51 (24) : 4555 -4560 . DOI: 10.20043/j.cnki.MPM.202408442
结核病(Tuberculosis,TB)是由结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染引起的慢性呼吸道传染病,对人类身体健康构成严重威胁,给全球公共卫生安全带来严峻挑战[1]。根据世界卫生组织(World Health Organization,WHO)结核病报告估计,2022年全球新发结核病患者约为1 060万例,中国新发患者约为74.8万,占全球发病数的7.1%,其排名仅次于印度尼西亚和印度[2]。自2004年起,全国和宁夏肺结核年度发病率均呈现逐年下降趋势,但2021年宁夏地区肺结核发病率却出现了反弹,达到了38.69/10万,表明该地区在肺结核防控工作上仍需高度重视[3]。利福平作为一线抗结核药物,具有显著的杀菌效果,对于结核病治疗至关重要,当MTB对利福平产生耐药性形成利福平耐药结核病(Rifampicin-resistant tuberculosis,RR-TB),导致治疗难度大、治愈率低、治疗周期变长,因此RR-TB仍需要重点关注[4]。本研究分析宁夏地区肺结核患者利福平耐药情况及影响因素,并运用熔解曲线间隔区寡核苷酸分型(Melting curve analysis-based Spoligotyping,McSpoligotyping)方法研究该地区MTB基因分布规律及聚类情况,构建基因数据库,为结核病的疫情防控提供依据。
选择宁夏回族自治区第四人民医院2020—2023年肺结核就诊患者,将实验室保存既往患者的样本复苏后转种至改良罗氏培养基培养,成功复活98株,经痰涂片检测均为阳性。痰涂片抗酸杆菌阳性结果判读标准参考《结核病实验室检验规程》[5]。本研究通过宁夏回族自治区第四人民医院伦理审查(编号2023-nsy-004)。
每位患者留取三份痰标本(即时痰、夜间痰与晨痰),根据三份痰标本涂片结果,选取其中两份进行培养,优先选取阳性和阳性级别较高的标本,当只有一份标本涂片阳性时,选取该阳性标本和阴性标本中质量较好的那一份进行培养[6]
GeneXpert MTB/RIF是一种基于实时荧光聚合酶链反应(Polymerase Chain Reaction,PCR)的检测方法,可以同时检测MTB和rpoB基因中的突变,从而快速判断利福平耐药性。将处理好的痰标本按照GeneXpert MTB/RIF仪说明书进行检测。
取400 μl MTB菌液进行超声分散,采用改良版十六烷基三甲基溴化铵法提取脱氧核糖核酸(deoxyribonucleic acid,DNA),琼脂糖电泳分析DNA完整性。实时PCR仪(致善SLAN48P)上完成扩增与溶解曲线分析步骤。
McSpoligotyping基因分型结果与SITVIT2(http://www.pasteur-guadeloupe.fr:8081/SITVIT2/uoload)数据库进行比对,获取间隔区寡核苷酸国际型别(Spoligo-international-type,SIT)编号及家系(Lineage)信息,再提交到MIRU-VNTRplushttp://www.miru-vntrpluse.org/MIRU/index.faces)网站中计算最小生成树进行聚类分析。
采用SPSS 26.0软件进行数据分析,计量资料用进行描述,计数资料用构成比或率进行描述,卡方检验或Fisher确切概率法进行组间比较,采用R 4.4.1软件进行多因素logistic回归分析并绘制森林图,检验水准α=0.05。
本研究共计样本98株,男性57例,女性41例,平均年龄53.02±19.70岁,其中对利福平耐药的MTB占13.27%(13/98),敏感的MTB占82.65%(81/98),无药敏结果的MTB占4.08%(4/98)。对利福平耐药菌株与敏感菌株感染的肺结核患者进行比较,两组患者在年龄、职业、民族和基因型别分布没有显著性差异(P>0.05),在性别、治疗史和地区的分布具有显著性差异(P<0.05)。复治患者发展为RR-TB的风险显著增加(OR=33.22,95% CI:3.11~355.43,P<0.05),来自中卫市和吴忠市的肺结核患者也表现出较高的利福平耐药风险(OR=19.42,95% CI:1.12~336.75,P<0.05;OR=43.25,95% CI:1.76~1062.70,P<0.05)。见表1图1
基于SITVIT 2数据库,98株MTB菌株McSpoligotyping分型呈现出3种家系,包括93株(94.90%)分离株,覆盖了13种不同的SIT,有5株(5.10%)分离株无法确定SIT被归类为新发现或未定义基因型。最大的家系为北京型,包含80株(81.63%)分离株,其次是T型、U型,分别为12株(12.24%)、1株(1.02%)。
根据特定SIT编号,北京型SIT 1有74株,北京型SIT 190、SIT 265、SIT 621、SIT 2979共6株。T型菌株的常见亚系为T1型(SIT 7、SIT 53、SIT 334、SIT 2905、SIT 3228)10株,其他亚系为T2型(SIT 848)1株、T3型(SIT 37)1株。相比之下,U家族家系非常单一,仅有Ural-2(SIT 3109)1株。
北京型广泛分布于宁夏各市,其中石嘴山市与固原市仅有北京型,而T型与新发现或未定义基因型在中部地区(中卫市、吴忠市、银川市)可见,吴忠市有4种基因型(北京型、T型、U型与新发现或未定义基因型)。见表2表3
经McSpoligotyping分型聚类分析,98株菌株分为2个不同的基因聚类分别为北京型、非北京型,聚类大小为80、9株,其余9株(9.18%)为独立的散在基因型,成簇率为90.82%(89/98)。在成簇的北京型中,SIT 1有74株(75.51%),SIT 190有3株,SIT 265与SIT 621各1株,新发现或未定义基因型1株,在非北京型中,T1型8株(SIT 7、SIT 53、SIT 334),T3型1株(SIT 37)。见图2
TB主要是通过排菌患者咳嗽、咳痰、打喷嚏时将带有MTB的飞沫散播于空气中形成气溶胶,健康人吸入后导致感染[7]。由于MTB潜伏时间长、发病不确定性以及菌株形态差异小等原因,传统流行病学方法很难研究MTB在人群中的传播规律,基因分型方法可调查结核病爆发和流行、追踪和寻觅传染源,确定疾病传播机制,也可鉴定实验室交叉污染或院内感染,最终揭示MTB菌株分布情况及优势株的性质[8]。McSpoligotyping技术是通过检测MTB基因组中间隔序列(spacers)的存在与否来进行分型,具有操作简便、准确度高和耗时短的特点[9],适用于医院、监狱和紧密地区等有限的环境中的流行病学调查和病原学监测[10],另外该分型结果容易记录与共享,有助于构建本地和全球的基因型数据库。
本研究对利福平耐药与敏感MTB感染的肺结核患者进行分析发现性别、治疗史与地区分布存在显著性差异,复治患者发展为RR-TB的风险增加,与既往治疗失败、既往不规范的抗结核治疗或治疗过程中断等有关。未按时、定量、全程服药,容易导致病情反复,治疗不彻底,体内耐药突变菌逐渐发展成为优势菌,从而增加了耐药风险和传播机会,与于海娟[11]、王少华[12]、宁红晓[13]和赵朝珍[14]等人的的研究结果一致。来自中卫市与吴忠市的肺结核患者也表现出较高的利福平耐药风险,由于该地区是旅游城市,每年都有大量的外源输入人群,人口流动可能导致MTB的快速扩散,增加了耐药菌株的传播机会。
北京型是世界各地MTB致病菌中最广泛的基因型[15],也是我国的主要流行基因型,该型菌株比其他型菌株更具选择优势[16]。本研究基于McSpoligotyping分型显示宁夏地区北京型MTB菌株占比为81.63%(80/98),与陕西(81.54%)[17]、河南(83.53%)[18]等北方地区结果相近,高于海南(54.41%)[19]、广西壮族自治区(56.86%)[20]等南方地区。非北京型占比为18.37%,可见宁夏地区感染北京型MTB的患者出现较高水平的流行,与王晓平等[21]对宁夏MTB分型结果相符。除北京型外,宁夏地区还流行T家族,与陕西[17]地区的主要流行菌株情况基本一致。此外,吴忠市还发现U基因型1株,该市有当地最大的畜牧产业,其中国内农产品“盐池滩羊”获得了国家认可的注册品牌,牲畜养殖业一直是当地经济的重要组成部分,MTB人兽共患情况需要进一步开展研究。
宁夏地区MTB聚类分析结果显示主要为北京型、非北京型两个不同的基因聚类,成簇率较高(90.82%),且远高于上海市(28.57%)[22]、重庆市(30.3%)[23]与贵州省(27.03%)[24]。成簇率高表明菌株间存在一定的亲缘关系[25],反映宁夏MTB可能具有一定的传播范围,但患者间是否存在空间交集与流行病学关联还需要进一步验证。北京型菌株包含5种SIT,其中SIT1占比最大(75.51%),提示其具有更强的传播率,可能存在爆发趋势;非北京型有8种SIT,主要为T1型,新发现或未定义型有5种SIT,提示宁夏地区MTB基因具有多态性。
本研究存在一些不足,Mcspoligotyping分型能有效区分北京型菌株,低于MIRU-VNTR(多位点可变数目串联重复序列)分型的分辨率,且成功分型的样本较小,可能低估其他基因型别菌株的流行情况,因此有待扩大样本进一步完善现有研究结论。
综上所述,宁夏地区在结核病防控工作中应采取多方位策略,包括开展健康教育,提高治疗依从性,加强中卫市、吴忠市的结核病筛查与耐药性监测,考虑地区间的MTB基因多样性和差异性,有效控制结核病的传播。
  • 宁夏自然科学基金项目(2024AAC05094)
  • 自治区卫健委科研项目(2022NWKY023)
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2024年第51卷第24期
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doi: 10.20043/j.cnki.MPM.202408442
  • 接收时间:2024-08-29
  • 首发时间:2026-03-18
  • 出版时间:2024-12-25
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  • 收稿日期:2024-08-29
基金
宁夏自然科学基金项目(2024AAC05094)
自治区卫健委科研项目(2022NWKY023)
作者信息
    1.宁夏医科大学公共卫生学院,宁夏 银川 750004
    2.宁夏回族自治区环境因素与慢性病控制重点实验室
    3.宁夏回族自治区第四人民医院

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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