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背景:入选病例为来自卢旺达4个省市的肺结核(TB)病人。目的:确定复发TB的原因。方法:分离2002年1月—2005年9月复发TB的一系列结核分枝杆菌菌株,进行spoligotyping(间隔区寡核苷酸分型法)和MIRU-VNTR(数目可变的串联重复序列和结核分枝杆菌散在分布重复单位)基因型分析。通过表型药敏检测和rpoB、katG、inhA、embB基因的测序来确定耐药状态。结果:纳入研究的710例痰培养阳性的TB病人中,638例获得初次发病的药敏结果,其中69例为耐多药结核(MDR-TB),569例为非MDR- TB。在MDR-TB病人中,22例得到多株分离株,其中12例为治愈后复发,10例为迁延不愈。12例治愈后复发的病人中,4例病人前后分离株的DNA指纹型不同,说明为再感染,其余8例及10例慢性病人的前后分离株DNA指纹型相同,复发原因分别为复燃和治疗失败导致。非MDR-TB病人中,1例复发,复发原因为初发时混合克隆感染的单克隆复燃。结论:上述结果说明MDR-TB的治疗失败率/复燃率均很高,依此推测2年以内的再感染并不是本地区复发TB的普遍原因。
Background: Selected cases were tuberculosis (TB) patients from 4 provinces and cities in Rwanda. Purpose: To determine the cause of recurrent TB. Methods: A series of M. tuberculosis isolates that recurred TB from January 2002 to September 2005 were isolated and subjected to spoligotyping (spacer oligonucleotide typing) and MIRU-VNTR (variable number of tandem repeats and tuberculosis Mycobacterium sporadic distribution of repeat units) genotype analysis. Drug resistance status was determined by phenotypic susceptibility testing and sequencing of rpoB, katG, inhA, embB genes. Results: Of the 710 sputum culture-positive TB patients included in the study, 638 received initial drug susceptibility results, of which 69 were MDR-TB and 569 were non-MDR-TB. Among MDR-TB patients, 22 isolates were obtained, of which 12 were cured after recurrence and 10 were delayed healing. Of the 12 patients who relapsed after treatment, the DNA fingerprints of 4 patients were different, indicating that they were re-infected. The DNA fingerprints of the other 8 and 10 chronic patients were the same, Treatment failed. One of the non-MDR-TB patients relapsed due to the reoccurrence of the mixed clone-infected monocyte in the first episode. Conclusion: The above results indicate that the treatment failure rate / revival rate of MDR-TB is very high. Therefore, it is speculated that re-infection within 2 years is not the common cause of recurrent TB in this area.