耐多药结核分枝杆菌双组份系统反应调节子表达的研究

目的 检测MTB耐多药菌株和敏感菌株的TCS反应调节子的表达水平,以筛选出与MTB耐药相关的TCS。方法将7H9肉汤培养至对数生长期的MTB进行总RNA的提取和纯度鉴定;然后进行反转录,利用SYBR Green I实时荧光定量PCR方法检测MTB的TCS反应调节子表达水平,以筛查出在耐多药菌株和敏感株中差异表达的TCS反应调节子。检测1NH、SM和LFA压力下这些差异表达的TCS反应调节子的表达水平。结果 与敏感菌株相比,在耐多药菌株中Rv0491、Rv3133c、Rv3143和Rv3246c分别上调表达1.03、7.11、3.48和1.37倍,差异有统计学意义（t或t'=5.623、-4.196、-3.559、-3.016,P＜0.01）。而其余反应调节子的表达在耐多药菌株和敏感菌株之间差异均无统计学意义。在抗生素压力下,Rv1027c、Rv3246c和Rv3143的表达明显升高,Rv0491和Rv3133c则变化不明显。结论Rv3246c和Rv3143的差异表达可能是MTB耐药的重要机制之一,可为新型抗结核药物的研制提供理论依据。     

rpoB基因在结核分枝杆菌利福平/利福布丁交叉耐药株中突变情况的差异分析

目的 了解结核分枝杆菌利福平/利福布丁交叉耐药株与利福平耐药/利福布丁敏感株rpoB全基因突变特征的差异.方法 测定rpoB全基因序列,比较278株利福平/利福布丁交叉耐药(rifampicin/rifabutin cross-resistant,RIF/Rfb-R)株和40株利福平耐药/利福布丁敏感(rifampicinresistant/rifabutin-susceptible,RIF-R/Rfb-S)株,30株利福平/利福布丁敏感(rifampicin-susceptible/rifabutin-susceptible,RIF-S/Rfb-S)株及标准株H37 Rv之间的rpoB全基因序列突变差异.结果 利福平/利福布丁敏感株和H37Rv rpoB全基因未发现突变;利福平/利福布丁交叉耐药株的常见突变位点是531(70.5％)和526( 20.9％).223( 80.2％)株单点突变株分别含有S531L、S531W、H526D、H526Y、H526R、Q513K、Q513P、Q510H、V176F、P287R、Y395C及H404Y单点突变,55( 19.8％)株多重突变株分别以S531L、H526R、H526Y、H526D、D516G和Q513K位点与其他位点联合突变为主.利福平耐药/利福布丁敏感株的常见突变位点分别是516(65.0％)、526( 17.5％)和533( 10.0％).21(52.5％)株单点突变株分别含有L533P、H526L、H526S、S522L、D516V、D516Y和D516F单点突变,19(47.5％)株多重突变株分别以D516V和L533P位点与其他位点联合突变为主.结论 本批标本中,利福霉素耐药株rpoB基因突变率为100％,利福平/利福布丁交叉耐药株与利福平耐药/利福布丁敏感株rpoB全基因单点突变株的突变位置或氨基酸替换类型、多重突变株的突变位置或组合类型以及常见突变位点或其氨基酸替换类型完全不同,rpoB全基因DNA序列分析对临床科学应用利福平和利福布丁有指导意义.     

结核分枝杆菌Rv1009结构域多肽的免疫学特性研究

目的 研究结核分枝杆菌Rv1009结构域多肽的免疫学特性.方法 用原核表达的Rv1009结构域多肽免疫BALB/c小鼠3次.每次间隔2周.用ELISA法检测免疫小鼠血清中特异性抗体滴度.分离免疫小鼠的脾淋巴细胞,体外用抗原再刺激后,用MTT比色法检测免疫小鼠脾淋巴细胞的增殖指数.ELISA方法检测淋巴细胞悬液中γ干扰素(IFN-γ)、白细胞介素(IL)-10和IL-12的产生水平.另一部分免疫的小鼠经尾静脉感染MTB毒株H37Rv,4周后,计数脾脏细菌负荷数.结果 Rv1009结构域多肽免疫小鼠血清特异性抗体滴度为1:12 800.淋巴细胞增殖指数为2.40±0.18,明显高于生理盐水对照组的0.90±0.21.ELISA方法检测Rv1009结构域多肽免疫组IFN-γ、IL-10和IL-12水平为(1432±30)ng/L、(503±11)ng/L和(311±11)ng/L,显著高于生理盐水对照组的(256±20)ng/L、(76±6)ng/L和(56±8)ng/L(P<0.01).与生理盐水免疫组(细菌负荷6.64±0.13)相比较,Rv1009结构域多肽免疫组小鼠,对攻击感染后抗MTB在脾脏中增殖有显著作用(细菌负荷为4.86±0.14,P<0.05),但不及BCG免疫组的3.81±0.16.结论 Rv1009结构域多肽有可能作为新型结核疫苗的候选组分.     

结核分枝杆菌Rv1884c和Rv0867c基因的克隆表达及其促生长作用的研究

目的 构建结核分枝杆菌Rv1884c和Rv0867c基因的原核表达质粒,获得结核分枝杆菌Rvl884c和Rv0867c基因的表达蛋白,并初步研究其促生长作用.方法 制备结核分枝杆菌基因组DNA,采用PCR技术扩增目的 基因片段;将2个片段分别克隆入克隆载体pGEx-4T-1和pUC19,再分别克隆入原核表达载体pGEX-4T-1和pPRO-EXHT,经序列测定证实正确后,再经异丙基硫代-β-D半乳糖苷(IPTG)诱导表达GST标记的Rv1884c融合蛋白和His标记的Rv0867c融合蛋白;用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分析重组蛋白的相对分子质量大小及表达形式.结果 成功扩增出了结核分枝杆菌Rv1884c和Rv0867c基因,构建了具有正确基因序列的质粒载体pGEX-4T-1-Rv1884c和pPRO-EXHT-Rv0867c,转化人大肠杆菌DH5α中经诱导产生高水平的表达产物.经SDS分析,在相对分子质量为45 000和80 000处出现新生蛋白带,凝胶薄层扫描检测表达量分别约占菌体蛋白的18.3%和23.7%.用GSTrap FF亲和层析柱和Ni2+-NTA纯化柱进行蛋白纯化,并研究这两种蛋白对藤黄微球菌、BCG和结核分枝杆菌H37Rv的促生长作用.结论 成功克隆了结核分枝杆菌Rv1884c和Rv0867c基因并得到了其大肠杆菌表达产物,为进一步研究Rv1884c和Rv0867c基因蛋白的活性及其功能,以及研究结核分枝杆菌快速促生长作用奠定了基础.     

katG基因二个不同区域基因变异与结核分枝杆菌异烟肼耐药的相关性研究

目的 分析结核分枝杆菌katG基因2个不同区域的基因变异,并确定与INH耐药的相关性.方法 从痰液分离并鉴定结核分枝杆菌耐INH菌株53株,用PCR扩增katG基因的2个区域:区域1为第1位密码子至150位密码子,区域2为第227位密码子至470位密码子,并分别测序.结果 3株对INH耐药但2个区域都不发生突变.14株区域1存在突变,其中5株只在区域1存在突变,5株在区域1出现缺失突变,并呈现高度耐药.点突变是区域2的主要特点,特别是S315位密码子,60.4%(32/53)S315发生突变,最常见的是S315N(AGC→AAC)(18株);katG S315在高度INH耐药和低度INH耐药的结核分枝杆菌中突变率分别是84.4%(27/32)、15.6%(5/32),两组间差异有统计学意义(x2=30.25,P＜0.01).27株S315突变呈高度耐药,占S315突变菌株总数的84.4%,其余18株至少有一个非S315点突变的耐药株中高度耐药只有5株,占27.7%,两组间差异有统计学意义(x2=16.02,P＜0.01).对INH耐药的结核分枝杆菌区域2的突变发生率为84.9%.5株只在区域1存在突变,通过检测基因突变诊断INH耐药的检出率上升至94.3%.结论 S315突变发生率最高,突变类型和位置与耐药程度密切相关,分析区域1能使检出率提高9.4%.

Abstract：

Objective To analyze and compare the mutations in two different regions of the katG gene and study the relevance of Mycobacterium tuberculosis isoniazid-resistance and mutations in two different regions of the katG gene. Methods Fifty-three INH-resistant Mycobacterium tuberculosis strains isolated in cultures of sputum samples obtained from Zhejiang province were analyzed. PCR was used to amplify two regions of the katG gene (GenBank accession no. U06258) region 1 (from codon 1 to codon 150) and region 2 ( from codon 227 to codon 470) which were then sequenced in order to identify mutations. Results Three strains resistant to INH did not contain mutations in either region. Fourteen strains carried mutations in region 1. Among them 5 strains barbered deletions, and showed high-level resistance to isoniazid. Five strains had mutations only in region 1. Region 2 carried multiple point mutations, especially at codon 315, and there were S315 N ( AGC→AAC ) substitution in 18 of those cases. The frequency of mutations in the katG S315 of high-level INH-resistance isolates ( 84. 4%, 27/32) was significantly higher than those of low-level INH-resistance isolates( 15.6%, 5/32 ), there was statistically significant difference (x2 = 30. 25, P ＜ 0. 01 ).katG S315 mutations in high-level INH-resistance frequency (84. 4%, 27/32) was significantly higher than the other mutations of katG gene of high-level INH-resistance frequency (27. 7%, 5/18 ), there was significant difference (x2 = 16.02, P ＜ 0. 01 ). The analysis of region 2 allowed INH resistance to be diagnosed in 84. 9% of the strains. Five strains had mutations only in region 1 ,which allowed the proportion of INH-resistant strains identified to be increased to 94. 3%. Conclusions The number of mutations at codon 315 was high. Mutation type and location closely related with drug resistance and the analysis of region 1 resulted in a 9. 4% increase in the rate at which mutations were identified.     

实时荧光PCR分子信标检测耐利福平结核分枝杆菌印rpoB基因

目的 应用实时荧光PCR分子信标技术,建立快速检测临床标本中结核分枝杆菌利福平rpoB相关耐药突变点方法,探讨其缩短耐药实验报告时间的临床应用价值.方法 以分枝杆菌药物敏感性实验绝对浓度法为标准,12株非结核分枝杆菌、4株非分枝杆菌作对照,对174例结核患者临床分离株应用实时荧光PCR分子信标方法,检测利福平rpoB核心区域的耐药突变点并将结果与直接测序进行比较.结果 (1)实时荧光PCR分子信标方法:82例结核分枝杆菌利福平敏感菌株中,3例发生rpoB基因突变,特异度为96.3%;92例结核分枝杆菌利福平耐药菌株中,82例检出耐药突变,敏感度为89.1%;准确性为92.5%.(2)DNA直接测序分析:82例结核分枝杆菌利福平敏感株中,1例发生rpoB基因突变,特异度为98.8%;92例结核分枝杆菌利福平耐药菌株中,83例发生:rpoB基因突变,敏感度为90.2%;准确性为94.2%.检测174株结核分枝杆菌临床分离菌株,与实时荧光PCR分子信标方法检测一致性为98.3%(171/174).结论 实时荧光PCR分子信标方法检测耐利福平结核分枝杆菌rpoB基因突变点可作为结核患者快速耐药检测的初筛方法之一.     

耐高三尖杉酯碱人SKM-1细胞系的建立及其生物学特性观察

目的 建立耐高三尖杉酯碱人SKM-1细胞系,初步探讨该细胞系的生物学特性及多药耐药机制.方法 通过较大剂量间断冲击逐渐增加药物浓度的方法培养人骨髓增生异常综合征转急性髓系白血病细胞系SKM-1细胞,建立耐高三尖杉酯碱的SKM-1细胞系,命名为SKM-1/HHT.光学显微镜下观察耐药细胞系和亲本细胞系的一般形态学变化,MTT法测定倍增时间和耐药指数,绘制生长曲线;利用流式细胞术检测细胞周期分布及细胞内柔红霉素含量;应用常规遗传学方法进行核型分析;采用荧光相对实时定量PCR方法检测多药耐药相关基因(mdr1及MRP)及topo-Ⅱa的表达.结果 历经7个月建立了耐药细胞系SKM-1/HHT.耐药细胞与亲本细胞的形态及免疫表型接近;耐药细胞核型与SKM-1细胞基本相同,但更为复杂,存在20、X、4、5、9、11号染色体差异;耐药细胞G1期细胞增多(64.04%对41.91%),S期细胞减少(34.92% 对53.53%),G2期细胞减少(1.04%对4.56%);耐药细胞对高三尖杉酯碱、长春新碱、柔红霉素、依托泊苷耐药性明显增加,耐药指数分别为17.94、8.75、5.99和13.76;耐药细胞内DNR荧光量明显低于亲本细胞(698±36 对858±54);耐药细胞mdr1表达水平明显增高,其2-ΔCt值为亲本细胞的20.1倍[(3.42±0.46)×10-2对(0.17±0.01)×10-2,P<0.05];MRP表达亦明显升高,2-ΔCt值为亲本细胞的3.56倍[(4.77±0.87)×10-3 对(1.34±0.56)×10-3,P<0.05];topo-Ⅱa基因表达在耐药细胞有所下降,耐药细胞与亲本细胞的2-ΔCt值之比为 0.619∶1[(1.91±0.30)×10-4对(3.08±0.21)×10-4,P<0.05].结论 建立了对高三尖杉酯碱耐药的SKM-1/HHT细胞系,其耐药机制主要涉及mdr1的过度表达而导致的细胞外排增强,MRP及topo-Ⅱa表达水平的改变可能也部分参与了这一过程.     

结核分支杆菌rpoB基因突变与对利福平耐药的关系

目的:研究结核分支杆菌耐利福平(RFP)分离株rpoB基因突变情况并评价英应用价值.方法:采用多聚合酶链式反应-单链构象多态性分析法(PCR-SSCP法)对60株结核分支杆菌rpoB基因进行检测.结果:以结核分支杆菌标准株H37Rv为对照,60株PCR扩增阳性的结核分支杆菌中,共有32株发生突变,总突变率为53.3%(32/60);24株药物敏感株有4株rpoB基因有突变,突变率为16.7%;36株耐药株中,28株rpoB基因有突变,突变率为77.8%.耐药菌株突变率明显高于敏感菌株的突变率(P<0.05).结论:rpoB基因突变是耐RFP结核分支杆菌耐药性的主要分子机制;应用PCR-SSCP可快速检测结核分支杆菌对RFP的耐药性.     

吗啡对HIV-1在MT2细胞和巨噬细胞中复制的影响

目的 附测定双抗体夹心法检测p24抗原表达.用Student-t检验或方差分析(ANOVA)比较不同细胞处理组间p24抗原表达差异;采用重复测量数据的方差分析比较不同时间吗啡处理组比对照组的p24抗原表达增加或减少倍数的变化趋势.结果 HIV-1感染MT2细胞后第3、4、5和6天,3个浓度的吗啡处理的(1)组的p24抗原表达[第3天:(4.44±0.30)、(5.59±0.25)和(4.60±0.24) ng/ml;第4天:(24.30±2.66)、(31.73±1.17)和(26.02±0.37) ng/ml;第5天:(56.30±1.26)、(81.77±2.49)和(63.66±2.57) ng/ml;第6天:(150.70±8.97)、(243.09±8.93)和(173.72±7.73) ng/ml]均高于(4)组[第3~6天分别为(1.93±0.05)、(8.03±0.09)、(15.30±0.91)、(41.01±0.84) ng/ml],差异有统计学意义(第3天:t值分别为14.15、24.74和19.14,P均<0.01;第4天:t值分别为10.59、34.92和81.2,P均<0.01;第5天:t值分别为45.83、43.51和30.07,P均<0.01;第6天:t值分别为20.09、39.02和29.55,P均<0.01).3个浓度的吗啡处理的(1)组的p24抗原表达比(4)组增加的倍数,随HIV-1感染MT2细胞的时间的延长具有上升的趋势,时间效应具有统计学意义(F=842.18,P<0.01).HIV-1感染巨噬细胞组后第4、6、8和10天,3个浓度的吗啡处理的(5)组的p24抗原表达[第4天:(0.68±0.15)、(0.87±0.41)和(0.75±0.09) ng/ml;第6天:(1.64±0.57)、(2.07±0.12)和(1.75±0.17) ng/ml;第8天:(6.31±0.17)、(8.81±0.34)和(7.19±0.11) ng/ml;第10天:(32.30±17.55)、(50.74±17.55)和(39.74±0.56) ng/ml]均高于(8)组[第4、6、8、10天分别为(0.60±0.01)、(1.16±0.07)、(3.84±0.45)、(17.55±0.86) ng/ml],差异有统计学意义(第4天:t值分别为7.27、11.06和3.02,P均<0.05;第6天:t值分别为8.93、11.3和5.45,P均<0.01;第8天:t值分别为8.83、15.11和12.42,P均<0.01;第10天:t值分别为13.65、17.84和36.69,P均<0.01).3个浓度的吗啡处理的(5)组的p24抗原表达比(8)组增加的倍数,随HIV-1感染时间的延长具有上升的趋势,时间效应具有统计学意义(F=135.58,P<0.01).结论 吗啡能够促进HIV-1在MT2细胞和巨噬细胞内的复制,并且随着感染时间的延长而增加;吗啡促进HIV-1复制的作用可被纳洛酮阻断.

Abstract：

Objective To determine whether Morphine has the ability to enhance HIV-1 replication in MT2 and Macrophage in vitro and assess the influence of Naloxone on Morphine2s effect.Methods MT2 cells were randomly assigned into 4 groups: (1) Morphine treatment for MT2 group, (2) Morphine+Naloxone co-treatment for MT2 group, (3) Naloxone treatment for MT2 group and (4) MT2 Control;Macrophages were also randomly assigned into 4 groups: (5) Morphine treatment for Macrophage group, (6) Morphine+Naloxone co-treatment for Macrophage group, (7) Naloxone treatment for Macrophage group and (8) Macrophage Control. Group (2), (3), (6) and (7) were pre-treated with 10-8 mol/L Naloxone for 0.5 h, and then group (1) and (2) were treated with 10-12, 10-10 and 10-8 mol/L Morphine for 24 h;group (5) and (6) were disposed of 10-10 mol/L Morphine for 24 h.All 8 groups were added in HIV-1 viral strain with 50% tissue culture infective dose(TCID50).P24 antigen in MT2 cells culture supernatant at day 3, 4, 5 and 6, and in Macrophages culture supernatant at day 4, 6, 8, 10 and 12 after infection were determined with ELISA.Student2s t-test and ANOVA were used to compare the differential expression in different groups, and repeated measures ANOVA was used to compare the increasing or decreasing expression of p24 antigen in morphine treatment groups than that in the control group at different time points.Results On the 3rd day of infection with HIV-1 in MT2 cells, the expression of p24 antigen in 10-12, 10-10 and 10-8mol/L dose of group (1) were (4.44?.30), (5.59?.25) and (4.60?.24) ng/ml respectively, compared to control[(1.93?.05) ng/ml, t= 14.15, 24.74 and 19.14, all P<0.01].On the 4th day, 10-12, 10-10 and 10-8mol/L dose of group (1) resulted in a significant increase of p24 antigen expression [(24.30?.66), (31.73?.17) and (26.02?.37) ng/ml]in culture supernatants compared to control[(8.03?.09) ng/ml, t=10.59, 34.92 and 81.2, all P<0.01].On the 5th day, the expression of p24 antigen in 10-12, 10-10 and 10-8 mol/L dose of group (1) were (56.30?.26), (81.77?.49) and (63.66?.57) ng/ml respectively, compared to control [(15.30?.91) ng/ml, t= 45.83, 43.51 and 30.07, all P<0.01].On the 6th day, the expression of p24 antigen in 10-12, 10-10 and 10-8 mol/L dose of group (1) were (150.70?.97), (243.09?.93) and (173.72?.73) ng/ml respectively, compared to control [(41.01?.84) ng/ml, t= 21.09, 39.02 and 29.55, all P<0.01].The enhanced multiple of p24 antigen expression in three doses of morphine treatment group compared to control increased with HIV-1 infected MT2 cells time, trend analysis of repeated measurements showed statistically significant time effect (F=842.18, P<0.01). On the 4th day of infection with HIV-1 in Macrophage cells, the expression of p24 antigen in 10-12, 10-10 and 10-8 mol/L dose of group (5) were (0.68?.15), (0.87?.41) and (0.75?.09) ng/ml respectively, compared to control [(0.60?.01) ng/ml, t= 7.27, 11.06 and 3.02, all P<0.05]. On the 6th day, 10-12, 10-10 and 10-8 mol/L dose of group (5) resulted in a significant increase of p24 antigen expression[(1.64?.57) , (2.07?.12 ) and (1.75?.17) ng/ml]in culture supernatants compared to control [(1.16?.07) ng/ml, t=8.93, 11.3 and 5.45, all P<0.01].On the 8th day, the expression of p24 antigen in 10-12, 10-10 and 10-8 mol/L dose of group (5) were (6.31?.17), (8.81?.34) and (7.19?.11) ng/ml respectively, compared to control [(3.84?.45) ng/ml, t=8.83, 15.11 and 12.42, all P<0.01]. On the 10th day, the expression of p24 antigen in 10-12, 10-10 and 10-8 mol/L dose of Morphine treated group were (32.30?7.55), (50.74?7.55) and (39.74?.56) ng/ml respectively, compared to control [(17.55?.86) ng/ml, t= 13.65, 17.84 and 36.69, all P<0.01].The enhanced multiple of p24 antigen expression in three doses of group (5) compared to control increased with HIV-1 infected Macrophage cells time, trend analysis of repeated measurements showed statistically significant time effect (F=135.58, P<0.01).Conclusions Morphine has the ability to enhance HIV-1 replication in MT2 cell and Macrophage. This Morphine-mediated increase of p24 antigen expression can be blocked by Naloxone.     

多重耐药鲍曼不动杆菌对替加环素耐药状况分析

目的 了解多重耐药鲍曼不动杆菌对临床常用抗生素及新药替加环素的耐药状况.方法 收集2008-2009年浙江省4所教学医院的602株临床分离鲍曼不动杆菌,采用琼脂稀释法检测其对13种临床常用抗生素的敏感性,以及对多黏菌素B和替加环素的敏感性.同时,采用PFGE技术对24株多重耐药鲍曼不动杆菌进行同源性分析,以确定菌株间的亲缘关系.结果 浙江省4家教学医院2008-2009年分离的鲍曼不动杆菌主要来自于呼吸道标本,2009年达到277株(86.0%),血液标本数量从2008年的15株(5.4%)下降到2009年的5株(1.5%),而其他标本无明显变化.鲍曼不动杆菌对临床常用的13种抗生素均有不同程度的耐药,耐药率35.0%～85.0%.与2008年相比,除左氧氟沙星和妥布霉素耐药率分别下降0.9%和9.0%以外,2009年其余抗生素耐药率均有不同程度地上升,头孢曲松和头孢吡肟耐药率增加了近10.0%,对碳青霉烯类抗生素亚胺培南和美罗培南的耐药率分别达到74.2%(239/602)和70.8%(228/602).鲍曼不动杆菌对替加环素显示了很高的耐药率,耐药率达到78.9%(475/602),而多黏菌素B耐药率仅为3.7%(22/602).PFGE分型显示2008-2009年24株鲍曼不动杆菌有6个克隆型,其中A型最常见,占50%.结论 鲍曼不动杆菌对替加环素的耐药加大了院内感染控制的难度,临床应加强控制,防止多重耐药菌的传播.

Abstract：

Objective To investigate the resistance of Acinetobacter baumannii to clinical common antibiotics and new drug tigecycline. Methods Six hundred and two Acinetobacter baumannii isolates were collected from 2008 to 2009 in four teaching hospitals in Zhejiang province. Agar dilution method was used to detect the resistance of 13 clinical commom antibiotics, polymyxin B and tigecycline. Homology analysis of 24 multi-drug resistant Acinetobacter baumannii strains was used to investigate the relationship of each strain with the method of pulsed field gel electrophoresis. Results From 2008 to 2009, the Acinetobacter baumannii isolates of four teaching hospitals in Zhejiang province were mainly isolated from respiratory specimens with the number of 277 (86.0%) strains in 2009, the number of blood samples decreased from 15 (5.4%) strains in 2008 to 5 ( 1.5% ) strains in 2009, and there were no obvious change in other specimens. Acinetobacter baumannii strains were resistant to 13 clinical common antibiotics at different degree, fluctuated from 35.0% to 85.0%. Compared with the resistance in 2008, levofloxacin and tobramyxin decreased 0. 9% and 9.0% in 2009, respectively. However, the resistance of other antibiotics increased at different degree, the resistance of ceftriaxone and cefepime increased about 10.0%, and the resistance of imipenem and meropenem increased to 74.2% (239/602) and 70.8% (228/602) in 2009,respectively. Acinetobacter baumannii showed high resistance to tigecycline with the percent of 78.9% (475/602), while it was only 3.7% (22/602) for polymyxin B. There were six cloning types among the 24 Acinetobacter baumannii isolates, and the most common type was type A with the percent of 50%.Conclusions The resistance of tigecycline makes the situation of nosocomial infectious more serious. It is necessary to control the transmission of multi-drug resistant Acinetobacter baumannii immediately.     

外排泵基因Rv1456c、Rv1457c、Rv1458c表达与结核分枝杆菌耐药关系探讨

目的研究外排泵基因Rv1456c、Rv1457c、Rv1458c的表达与结核分枝杆菌（MTB）不同耐药表型的关系。方法提取2017 — 2018年浙江省宁波市疾病预防控制中心耐药监测期间收集的102株MTB核糖核酸（RNA），应用实时荧光定量PCR方法检测ABC转运蛋白超家族外排泵基因Rv1456c、Rv1457c、Rv1458c的表达量，采用Mann-Whitney U检验分析外排泵基因表达在不同耐药表型菌株中的差异。结果Rv1457c和Rv1458c基因表达量在利福平耐药组中的中位数及四分位数间距［0.507（0.378 ~ 1.444），1.842（1.325 ~ 2.628）］高于利福平敏感组［0.418（0.357 ~ 0.618），1.545 （1.189 ~ 2.065）］，差异有统计学意义（Z＝2.030、2.108，均P＜0.05）。 耐多药组Rv1457c和Rv1458c基因表达量的中位数及四分位数间距［0.538（0.419 ~ 1.490），1.941（1.471 ~ 2.659）］，高于非耐多药组［0.415 （0.337 ~ 0.618），1.533 （1.122 ~ 2.056）］，差异有统计学意义（Z＝2.865、2.896，均P＜0.05）。 异烟肼耐药组和敏感组中Rv1456c、Rv1457c的高表达率均存在差异（χ2＝4.858、6.789，均P＜0.05），利福平耐药组和敏感组中Rv1456c的高表达率差异有统计学意义（χ2＝8.424，P＜0.05），链霉素耐药组和敏感组中Rv1457c的高表达率差异有统计学意义（χ2＝4.545，P＜0.05），乙胺丁醇耐药组和敏感组中Rv1456c、Rv1457c的高表达率差异均有统计学意义（χ2＝5.142、10.202，均P＜0.05）。结论外排泵基因Rv1457c、Rv1458c的相对表达量增加与MTB对利福平耐药有关。     

江苏省海门市耐药肺结核病流行现状分析

目的 了解江苏省海门市耐药肺结核病流行现状、流行特点与危险因素,探索耐药肺结核病的防治方法. 方法 自2009年10月至2013年9月,对到海门市结核病防治机构就诊的全部336例痰涂片阳性肺结核患者的痰标本进行痰培养检查,所有涂阳患者连续纳入,不得跳选.对培养阳性的菌株进行菌型鉴定.对结核分枝杆菌菌株进行4种一线抗结核药物异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)敏感试验检查.计数资料的比较采用2分析,检验水准=0.05. 结果 4年共培养成功获得阳性菌株317株,其中结核分枝杆菌310株.在310株结核分枝杆菌分离株中,总耐药率24.5%(76/310),单耐药率9.7%(30/310),多耐药率2.9%(9/310),耐多药率11.9%(37/310).复治涂阳患者总耐药率和耐多药率均高于初治涂阳患者(2=55.294,P0.005, 2=71.471,P0.005).涂阳患者菌株单耐药谱中分离菌株对SM和INH单一耐药的比例较高,分别达46.7%和36.7%.多耐药谱中分离菌株对INH+SM耐药比例较高,占88.9%.耐多药谱中分离菌株以耐INH+RFP和耐INH+RFP+SM组合所占比例较高,分别达46.0%和29.7%. 结论 海门市耐多药肺结核病的流行较为严重,应加强耐多药肺结核病的发现和治疗管理工作.复治肺结核患者发生耐药的危险性较初治患者更高,应加强正规治疗等结核病防治知识的宣传、培训,重视对初治肺结核患者的治疗管理.     

耐多药结核分枝杆菌耐药相关基因突变特征分析

目的了解中国耐多药结核分枝杆菌耐药相关基因的分子特征。方法对138株耐多药结核分枝杆菌和45株敏感菌的耐药相关基因inhA、katG和oxyR-ahpC间隔区(异烟肼)、rpob(利福平)、gyrA(氧氟沙星)和rrs(卡那霉素)进行序列测定,分析其基因突变特点。结果 138株耐多药结核分枝杆菌中,14.4%的菌株inhA基因发生突变,72.5%菌株的katG基因发生突变,15.9%菌株的oxyR-ahpC基因发生突变,同时考虑这3种基因,异烟肼耐药相关基因突变检出率可达90.6%;94.2%菌株的rpoB基因发生突变,74.5%菌株的gyrA基因发生突变,61.1%菌株的rrs基因发生突变,主要的突变位点为katG315(66.7%),inhA-15(9.4%),oxyR-ahpC-10(5.1%),rpoB516(13.8%),526(26.1%)和531(49.3%),gyrA90(21.6%)和94(51%),rrs1401(61.1%)。结论我国耐多药结核菌异烟肼、利福平、氧氟沙星和卡那霉素耐药相关基因最常见突变为katG315、inhA-15,rpoB531、526和516,gyrA94和90,rrs1401。     

噬菌体裂解法检测结核杆菌药物敏感性的研究

目的利用结核分支杆菌噬菌体裂解法检测结核杆菌对利福平、异烟肼、链霉素敏感性。方法选用传统方法判定为利福平、异烟肼、链霉素的耐药或敏感菌株,采用噬菌体裂解法检测其对以上三种药物的敏感性,对比其特异性和敏感度。结果运用噬菌体裂解法检测结果显示,异烟肼药物浓度为1μg/ml时,其灵敏度为87.0%,特异度为93.3%,与传统方法的符合率为92.0%;链霉素药物浓度为4μg/ml时,其灵敏度为96.2%,特异度为92.0%,与传统方法的符合率为92.9%;利福平药物浓度为5μg/ml时,其灵敏度为91.4%,特异度为96.2%,与传统方法的符合率为94.7%。结论采用噬菌体裂解法检测结核杆菌药物敏感性简便易行,灵敏度、特异度高,与传统方法比较符合率较高,便于临床推广。     

浙江省宁波地区974例初治肺结核病例耐药情况分析

目的初步了解浙江省宁波地区初治肺结核病例耐药情况,对现行结核病控制策略效果进行评价。方法按照世界卫生组织《结核病耐药监测指南》(WHO/IUATLD)的要求对初治病例痰培养阳性菌株进行异烟肼、利福平、链霉素和乙胺丁醇4种抗结核药物的敏感性测定及菌群鉴定。结果研究共纳入结核分枝杆菌974株,初治患者总耐药率为29.8%,耐多药率为5.0%。初治耐药病例中,18.5%仅对1种药物耐药,4种药物的耐药率顺位由高到低依次为链霉素(18.5%)、异烟肼(16.7%)、利福平(6.7%)、乙胺丁醇(5.2%)。与1999年耐药监测初治患者总耐药率17.8%相比,宁波市初治患者总耐药率上升差异有统计学意义(χ2=13.463,P0.005),耐多药率水平也呈现升高趋势,结核分枝杆菌耐药性发生更趋向于单一耐药。结论宁波地区结核病耐药形势依然严峻,需进一步加强结核病防治工作。     

应用多重PCR-单链构象多态性分析同时检测耐异烟肼和利福平的结核分枝杆菌

目的 探讨应用多重PCR-单链构象多态性分析(multiplexpulymerase chain reaction-single strand conformation polymorphism,multi-PCR-SSCP)方法快速、特异地同时快速检测结核分枝杆菌对异烟肼和利福平耐药性的效能.方法 根据结核分枝杆菌的inhA序列、katG序列、rpoB序列,分别设计出3对特异性寡聚核苷酸引物.采用multi-PCR-SSCP技术,一次性检出耐异烟肼和利福平的结核分枝杆菌.新方法的有效性通过116株临床分离株(70株耐异烟肼,66株耐利福平)的验证.结果 名 Multi-PCR-SSCP方法检测临床分离株基因突变的有效性,以细菌培养和药敏试验结果为金标准.116株临床分离株和H37Rv标准株中除了4株katG缺失突变,其余菌株3个基因katG、inhA和rpoB在单基因PCR中都扩增成功.与H37Rv标准株相比,46株katG基因突变,14株inhA基因突变,58株rpoB基因突变.38株katG和rpoB,4株inhA和rpoB,4株inhA和katG同时突变,还有2株3个基因都有突变.multi-PCR-SSCP对于耐异烟肼和利福平的结核分枝杆菌检出的敏感度分别为80%、82%,特异度分别为100%和92%.结论 multi-PCR-SSCP方法敏感、特异,能同时快速有效地检测耐多药结核分枝杆菌,有望成为临床指导用药的好方法,为深入研究耐药基凶检测奠定了良好的基础.     

In-vitro activity of ofloxacin against Mycobacterium tuberculosis and its clinical efficacy in multiply resistant pulmonary tuberculosis

The in-vitro susceptibilities to ofloxacin of 159 clinical sputum isolates of Mycobacterium tuberculosis, comprising 95 isolates sensitive to all drugs, 31 isolates resistant to streptomycin or isoniazid or both, 27 isolates resistant to streptomycin, isoniazid and rifampicin and six isolates resistant to rifampicin (and in three cases to other drugs) were determined. Favourable MICs of ofloxacin (0.63-1.25 mg/l) were demonstrated for 147 isolates (92%). Twenty-two patients with resistant strains (including one patient with rifampicin intolerance) were studied: ten were given 300 mg ofloxacin and ten were given 800 mg ofloxacin, once daily in both cases, together with second-line accompanying drugs, for nine months to one year. Two received 800 mg of ofloxacin once daily alone for similar periods. In the 300 mg-ofloxacin group and the 800 mg-ofloxacin group, five and eight patients, respectively, achieved culture conversion; the rest failed. In the former group, the peak serum ofloxacin concentrations were 3.71-8.08 mg/l and the mean sputum/serum ratio was 0.85. In the latter group, the corresponding values were 10-18.7 mg/l, and 0.76, respectively. All patients tolerated the drugs well. Analysing only patients with accompanying drugs, those on ofloxacin 800 mg once daily had more rapid sputum culture conversion than those on ofloxacin 300 mg once daily (Mann-Whitney Wilcoxon Rank Sum Test: P less than 0.05), indicating more rapid bacteriolysis and implying the definite efficacy of ofloxacin when used together with second-line accompanying drugs in the management of resistant tuberculosis.     

云浮地区肺结核病患者结核分枝杆菌复合群耐药性分析

目的 分析云浮地区肺结核病患者结核分枝杆菌复合群(MTBC)耐药特点,为制定个体化治疗方案提供指导.方法 收集云浮市区及4个县区结核病门诊初诊结核病患者痰培养阳性菌株1571株,采用对硝基苯甲酸(PNB)鉴定培养管进行MTBC鉴别试验;采用比例法进行菌株对9种抗结核病药物(4种一线,5种二线)的体外药物敏感性试验.结果...     

C5a对内皮细胞表达血栓调节蛋白的影响

目的 探讨补体C5a对人脐静脉内皮细胞(HUVECs)血栓调节蛋白(TM)表达的影响.方法 体外培养HUVECs,以终浓度200 μg/L重组人C5a刺激HUVECs 8、12、16、20 h以及以终浓度100、200、300 μg/L的C5a刺激HUVECs 12 h,采用实时荧光定量聚合酶链反应(PCR)、蛋白质免疫印迹法(Western blotting)分别检测TM的mRNA及蛋白表达变化;观察C5a对其表达TM的时-效和量-效关系.结果 C5a抑制了HUVECs在TM的mRNA和细胞膜表面蛋白水平表达.同时,C5a对TM表达的抑制作用存在时-效关系[8、12、16、20 h时蛋白为(93.11±1.57)×10-2、(71.05±3.39)×10-2、(65.48±4.28)×10-2、(62.69±4.03)×10-2,mRNA为(301.71±80.40)×10-6、(38.29±20.24)×10-6、(8.82±2.66)×10-6、(7.05±0.80)×10-6],且均于12 h后降低程度明显减缓(P均<0.05);并存在量-效关系[C5a 100、200、300 mg/L时蛋白为(113.25±3.97)×10-2、(80.18±2.56)×10-2、(73.22±4.36)×10-2,mRNA为(401.77±20.46)×10-6、(31.12±3.51)×10-6、(18.19±1.46)×10-6],TM蛋白在C5a 300 μg/L、mRNA在C5a 200 μg/L时刺激12 h降低程度明显减缓(P均<0.05).结论 C5a通过抑制TM的结构基因表达,进而减弱TM的蛋白翻译,从而参与了脓毒症时凝血亢进、炎症损害的病理生理过程.