耐异烟肼结核分枝杆菌临床分离株耐药相关基因突变研究

目的阐明结核分枝杆菌耐异烟肼临床分离株katG、inhA、ahpC、kasA及oxyR基因突变特点。方法对144株结核分枝杆菌临床分离株(耐异烟肼菌株101株;异烟肼敏感株43株)的katG、inhA、kasA、ahpC及oxyR基因进行DNA片断扩增及DNA序列分析,与GeneBank中结核分枝杆菌标准序列进行比较。结果(1)耐异烟肼菌株中未发现katG完全缺失,81株耐药株(80.2%)katG存在点突变、缺失或插入,其中16个突变位点未见报道;39株(38.6%)耐药株第315位点突变,低耐药菌株(1μg/ml)第315位点突变率显著高于高耐药菌株(10μg/ml;χ2=9.31,P<0.05);58株(57.4%)耐药株第463位点突变。23株(53.3%)敏感株第463位点突变。(2)5株(4.9%)耐药株inhA发生突变。敏感株inhA无突变。(3)3株(2.9%)耐药株ahpC发生突变。敏感株ahpC无突变。(4)17株(16.8%)耐药株kasA发生突变。敏感株中3株菌株Gly312Ser突变。(5)在全部菌株中未发现oxyR基因突变。(6)综合本项研究中各基因的突变情况,共有91株耐异烟肼菌株发生与异烟肼耐药相关的突变。结论本项研究进一步证实了结核分枝杆菌耐异烟肼与katG、inhA、ahpC及kasA基因突变之间的关系,并且提示还有其他机制参与异烟肼耐药。

Characterization of the katG, inhA, ahpC, kasA，and oxyR gene mutations in isoniazid-resistant and susceptible strains of Mycobacterium tuberculosis by automated DNA sequencing

OBJECTIVE: To study the characteristics of katG, inhA, ahpC, kasA, and oxyR gene mutations in isoniazid-resistant clinical isolates of Mycobacterium tuberculosis. METHODS: A total of 101 isoniazid-resistant and 43 susceptible strains of Mycobacterium tuberculosis were analyzed by PCR and sequence analysis of their katG, inhA, ahpC, kasA, and oxyR genes. RESULTS: (1) Sequencing of katG from 101 INH-resistant strains showed point mutations, small deletions or insertions in 81 isolates (80.2%), but no complete deletions were identified. The mutations at 16 position were found for the first time. Point mutations at position 315 were found in the genomes of 38.6% (39/101) of isoniazid-resistant strains. Low level isoniazid resistant strains (1 microg/ml) had higher mutation frequency at 315-Ser than high level isoniazid resistant strains (10 microg/ml; chi(2) = 9.31, P < 0.05). Mutations at position 463 were detected in 58 (57.4%) isoniazid-resistant strains. Arg463leu was also present in 23 of 43 susceptible strains. (2) Mutations in inhA genes were identified in 5 isoniazid-resistant isolates (4.9%). None of the susceptible strains contained any mutation in inhA genes. (3) Only 3 isolates in the 101 (2.97%) isoniazid-resistant clinical isolates had mutations in ahpC genes. No mutations were identified in the ahpC genes in 43 isoniazid-susceptible isolates. (4) Mutations in kasA genes were present in 17 of 101 (16.8%) isoniazid-resistant isolates. However, G312S was also present in 3 of 43 susceptible strains. (5) None of the isoniazid-resistant strains and susceptible isolates contained oxyR gene mutation. (6) Taken together, 91 of 101 (90%) isoniazid-resistant strains had mutations in katG, inhA, ahpC, and kasA genes which were associated with drug resistance. CONCLUSION: These studies provide further evidence supporting the association between katG, inhA, ahpC, and kasA gene mutations and INH resistance in Mycobacterium tuberculosis, while other mechanisms of INH resistant may exist.