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目的了解广东省结核分枝杆菌(MTB)随时间、地区的动态流行分布特点。方法应用24位点MTB散在分布重复单位(MIRU)分析广东省2013年455例MTB,筛选适合广东省分型的最佳MIRU组合,然后应用该最佳MIRU组合分析广东省2009年的173例、2013年的455例及2015年的225例MTB,此外,结合RD105缺失基因法鉴定这些菌株中的北京家族菌株,比例法进行药物敏感性试验(DST),聚类分析采用Bio Numerics(7.6)。结果 2015年北京家族菌株比率(70.2%)高于2009年(59.5%)和2013年(59.3%),其中,中部地区比率最高(71.3%),东部地区最低(55.0%)。MIRU-24位点的多态性存在差异,MIRU-12(HGI=0.999 1)能达到MIRU-15(HGI=0.999 2)相近的分辨率,MIRU-8分辨率较好(HGI=0.998 5)。853例MTB的系统发生树(MST)主要包括1个北京家族和2个非北京家族复合群,可分为Ⅰ、Ⅱ两群,广东省MTB的主要流行群是Ⅱ群,Ⅰ群中2009、2013年菌株比率高于2015年,东部地区菌株比率高(43.069%),中部地区低(27.206%),Ⅱ群则与之相反,北京家族菌株的MST主要包括1个复合群,包含407个独特型和46个簇。非北京家族菌株的MST主要包括2个复合群,包含309个独特型和6个簇。另外,广东省不同年份多药耐药(MDR)(χ~2=2.176,P=0.337)和广泛耐药(XDR)(χ~2=1.468,P=0.480)耐药率差异无统计学意义(P>0.05)。结论北京家族菌株是广东省的主要流行株,且随时间存在上升趋势,中部地区比率最高,该省MDR和XDR耐药趋势相对稳定,MIRU分型用于广东省MTB的分子流行病学研究可取得满意结果。
Objective To understand the dynamic distribution of Mycobacterium tuberculosis (MTB) over time and area in Guangdong Province. Methods 45 sites of MTB in Guangdong Province in 2013 were analyzed by using 24-site MTB scattered distribution units (MIRU), and the best MIRU combinations suitable for Guangdong genotyping were screened. Then, the best MIRU combination was used to analyze 173 cases of Guangdong Province in 2009, 455 cases in 2013 and 225 cases in 2015. In addition, Beijing strains of these strains were identified by RD105 deletion gene method, and the drug sensitivity test (DST) was carried out by proportional method. Bioinformatics (7.6) was used for cluster analysis. Results In 2015, the rate of family strains in Beijing was 70.2% higher than that in 2009 (59.5%) and 2013 (59.3%), of which the highest rate was 71.3% in Central China and the lowest was 55.0% in Eastern China. The difference of MIRU-24 polymorphism was similar with that of MIRU-12 (HGI = 0.999 1), MIRU-8 (HGI = 0.999 8 5) . The phylogenetic tree (MST) of 853 MTBs mainly consisted of one Beijing family and two non-Beijing family complex, which could be divided into two groups Ⅰ and Ⅱ. The major epidemic group of MTB in Guangdong province was Ⅱ group, In 2013, the strain rate was higher than that in 2015, with a high strain rate (43.069%) in the eastern region and a low (27.206%) in the central region. In contrast, in the second group, the MST of the Beijing family strains mainly consisted of one complex group comprising 407 unique Type and 46 clusters. The MST of non-Beijing family strains mainly includes two complex groups, including 309 unique types and 6 clusters. In addition, there was no significant difference in MDR (Multidrug Resistance) (χ ~ 2 = 2.176, P = 0.337) and XDR (χ ~ 2 = 1.468, P = 0.480) (P> 0.05). Conclusion The Beijing family strains are the major epidemic strains in Guangdong Province, with the upward trend over time, the highest rate in the central region, the trend of MDR and XDR resistance in the province is relatively stable, MIRU typing for molecular epidemiology of MTB in Guangdong Province may be Achieve satisfactory results.