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目的:评价摩洛哥卡萨布兰卡慢性肺结核病人分离结核分枝杆菌的耐药性以及耐药型。方法:在1996年2月-2001年9月间,从112例病人分离到122株结核分枝杆菌。男女性别比为2.4。结果:1996年2月-1997年5月,分离菌株的耐多药(MDR)率为77.5％,1999年2月-2000年5月为69.4％,2000年6月-2001年9月为78.7％。本研究期间耐多药率一直比较稳定。利用DNA测序技术通过对42株结核分枝杆菌(37株耐药,5株敏感)rpoB基因的69bp 高变区进行的分析发现,在rpoB513、rpoB516、rpoB522、rpoB523以及rpoB526密码子上存在9种不同类型的变异。在1株分离菌 株的rpoB523密码子上新发现了一个点突变。有4株耐药分枝杆菌的rpoB区域无变异。结论:MDR-TB的高流行率揭示了一个严重问题。公共卫生当局已经针对此类病人引入了一个新的治疗方案,包括3个月的卡那霉素、氧氟沙星、吡嗪酰胺和乙胺丁醇,继以18个月的氧氟沙星、吡嗪酰胺和乙胺丁醇(3KOZE/18OZE),希望通过在强化期加用氧氟沙星来降低耐药率。
OBJECTIVE: To evaluate the drug resistance and drug resistance of Mycobacterium tuberculosis isolated from patients with chronic tuberculosis in Casablanca, Morocco. Methods: From February 1996 to September 2001, 122 strains of Mycobacterium tuberculosis were isolated from 112 patients. Male to female ratio of 2.4. Results: The MDR rate of isolated isolates was 77.5% from February 1996 to May 1997, 69.4% from February 1999 to May 2000, and 78.7% from June 2000 to September 2001 %. MDR rates have remained relatively stable during the study period. Analysis of 69 bp hypervariable regions of 42 strains of M. tuberculosis (37 resistant and 5 susceptible) using DNA sequencing showed that there were 9 kinds of codons in rpoB513, rpoB516, rpoB522, rpoB523 and rpoB526 Different types of variation. A point mutation was newly found on the rpoB523 codon of one isolates. There were no mutations in the rpoB region of 4 resistant mycobacteria. Conclusion: The high prevalence of MDR-TB reveals a serious problem. Public health authorities have introduced a new treatment regimen for these patients, including kanamycin, ofloxacin, pyrazinamide and ethambutol for 3 months followed by ofloxacin for 18 months , Pyrazinamide and ethambutol (3KOZE / 18OZE), hoping to reduce the drug resistance by adding ofloxacin during the strengthening phase.