目的了解上海市1985～1995年结核分支杆菌原发耐药性。方法采用绝对浓度的间接法进行6种抗结核药物的耐药性测定。结果耐SM、INH、RFP、PAS和KM率由1985～1986年的10.2%、5.2%、4.8%、5.6%和3.9%下降至1994～1995年的4.8%、4.8%、4.3%、3.6%和2.6%，耐EMB率由113%上升至313%；总耐药率由1985～1986年的1516%下降至1994～1995年的812%；耐1药、2药、3药、4药、5药和6药的耐药率分别由5.9%、4.6%、2.5%、1.5%、0.4%和0.8%降至1.9%、3.5%、1.2%、1.2%、0.1%和0.4%。耐INH、RFP率1992～1993年为1.9%，1994～1995年为2.4%。结论上海市结核分支杆菌原发耐药性10年来呈下降趋势，但耐多药菌株仍占一定比例。

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.