目的探讨耐多药结核分枝杆菌耐药基因突变与耐药性的关系。方法用聚合酶链反应和聚合酶链反应单链构象多态性分析对128株结核分枝杆菌临床分离株耐利福平（moB）、链霉素（rpsL）和异烟肼（KatG）基因检测。结果38株敏感株中，各有1株（2.6%）测出rpoB、rpsL和KatG突变；90株耐多药株中，分别有8l株（90.0%）、71株（78.9%）和63株（70.0%）测出rDOB、rDsL和KatG突变；有77株（85.6%）同时测出2种以上耐药基因突变；10株耐其他药物株中，仅有1株测出KatG基因突变。结论85.6%的耐多药结核分枝杆菌存在2种以上耐药基因突变，且耐药基因突变率与耐药浓度有关。

Rapid detection of drug resistance in Mycobacterium tuberculosis is essential for efficient treatment and control of this pathogen. The amplification refractory mutation system (ARMS) was used to detect mutations in the rifampin resistance-determining region of the rpoB gene. A total of 39 rifampin-resistant M. tuberculosis isolates in Shanghai were analyzed by this assay, resulting in 92.3% sensitivity (36 of 39) and 87.2% concordance (34 of 39) relative to DNA sequencing, by which 41 mutations of 11 different types, including 9 point mutations and 2 deletions, were identified in the rpoB gene. The most frequent mutations were those associated with codon 531 (21 of 39 [53.8%]) and codon 526 (9 of 39 [23.1%]). The results suggest that the ARMS assay is rapid and simple to implement and could be performed for detection of rifampin resistance in M. tuberculosis to complement conventional culture-based methods.

目的建立结核分枝杆菌（结核菌）链霉素耐药性的噬菌体快速检测技术，并探讨其临床应用价值。方法应用分枝杆菌噬菌体感染结核菌建立链霉素耐药性的噬菌体检测技术，并对最佳测定条件进行探讨；将所建立的方法用于38株世界卫生组织药敏质控株和372株临床分离株链霉素耐药性测定，并与绝对浓度法和Bactec960药敏结果比较，对不符合菌株进行最低抑菌浓度（MIC）和rpsL耐药基因检测。结果链霉素终浓度5μg/ml作用24h、噬菌体108噬菌体形成单位/ml感染60min、杀毒剂5%室温作用5min为选择的检测条件。噬菌体法检测38株药敏质控株结果完全符合。372株临床分离株链霉素耐药性检测结果表明，如以绝对浓度法药敏结果为判断标准，则本法敏感性为97.4%、特异性为91.0%、阳性预测值为81.7%、阴性预测值为98.9%、准确性为92.9%；如以Bactec960药敏结果为判断标准，则本法敏感性为97.2%、特异性为97.1%、阳性预测值为94.6%、阴性预测值为98.5%、准确性为97.1%。有22株噬菌体法药敏结果与常规药敏试验结果不符，其中的11株噬菌体法检测结果与MIC和rpsL耐药基因检测结果相同。结论噬菌体法检测链霉素耐药性快速、简便，具有很高的敏感性和特异性，可作为结核菌链霉素耐药性的快速检测方法。