Abstract：
BACKGROUND: Multi-drug resistant tuberculosis (MDR-TB) results in treatment failure and poor clinical outcomes. This study was carried out with the aim to determine the pattern of drug resistance against Mycobacterium tuberculosis towards first line ATT (anti-tubercular treatment) in sputum smear-positive patients using Line Probe Assay (LPA).
METHODS: A cross sectional prospective study was carried out in a tertiary care Hospital of Meerut. A total of 898 sputum samples (on spot and early morning) collected from 449 suspected pulmonary tuberculosis patients as per RNTCP guidelines were screened by microscopy. Decontamination was done by N-acetyl-l-cysteine and sodium hydroxide. Then smear positive samples were subjected to 1st line drug susceptibility testing (DST) using LPA GenoType® MTBDRplus (HAIN Life Science) assay, a molecular method which allows rapid detection of Rifampicin (Rif) and Isoniazid (INH) resistance.
RESULTS: The overall burden of MDR TB in this geographical area was 7.9 %. Mono-resistance with Rif alone was around 2.8 %. However, the mono-resistance with INH (inhA gene) and INH (katG gene) was 2.8 % and 1.1 % respectively. Drug resistance of Rif was due to mutations in rpoB gene while resistances to INH were more commonly due to mutation in inhA gene followed by katG gene. TB was more commonly seen in the age group of 30-59 years (43.8 %) and predominantly in males.
CONCLUSIONS: Tuberculosis positivity rate is high in Western Uttar Pradesh. Burden of MDR TB in Western Uttar Pradesh was similar to National data. Line probe assay can be used as a primary method to diagnose multi drug resistant TB as done in present study which can help in earlier initiation of correct therapy.
METHODS: A cross sectional prospective study was carried out in a tertiary care Hospital of Meerut. A total of 898 sputum samples (on spot and early morning) collected from 449 suspected pulmonary tuberculosis patients as per RNTCP guidelines were screened by microscopy. Decontamination was done by N-acetyl-l-cysteine and sodium hydroxide. Then smear positive samples were subjected to 1st line drug susceptibility testing (DST) using LPA GenoType® MTBDRplus (HAIN Life Science) assay, a molecular method which allows rapid detection of Rifampicin (Rif) and Isoniazid (INH) resistance.
RESULTS: The overall burden of MDR TB in this geographical area was 7.9 %. Mono-resistance with Rif alone was around 2.8 %. However, the mono-resistance with INH (inhA gene) and INH (katG gene) was 2.8 % and 1.1 % respectively. Drug resistance of Rif was due to mutations in rpoB gene while resistances to INH were more commonly due to mutation in inhA gene followed by katG gene. TB was more commonly seen in the age group of 30-59 years (43.8 %) and predominantly in males.
CONCLUSIONS: Tuberculosis positivity rate is high in Western Uttar Pradesh. Burden of MDR TB in Western Uttar Pradesh was similar to National data. Line probe assay can be used as a primary method to diagnose multi drug resistant TB as done in present study which can help in earlier initiation of correct therapy.
摘要：
背景：耐多药结核病（MDR-TB）导致治疗失败和临床预后不良。进行这项研究的目的是使用线探针测定（LPA）确定痰涂片阳性患者对一线ATT（抗结核治疗）的结核分枝杆菌耐药性模式。
方法：在Meerut的三级保健医院进行了一项横断面前瞻性研究。根据RNTCP指南，从449名疑似肺结核患者中收集了898份痰样本（现场和清晨），通过显微镜进行了筛选。通过N-乙酰基-1-半胱氨酸和氢氧化钠进行去污。然后使用LPAGenoType®MTBDRplus（HAINLifeScience）测定法对涂片阳性样品进行一线药敏试验（DST），一种可以快速检测利福平（Rif）和异烟肼（INH）耐药性的分子方法。
结果：该地理区域耐多药结核病的总体负担为7.9％。单独使用Rif的单抗性约为2.8%。然而,INH（inhA基因）和INH（katG基因）的单抗性分别为2.8％和1.1％。Rif的耐药性是由于rpoB基因的突变，而对INH的耐药性更常见的是由于inhA基因的突变，然后是katG基因。结核病更常见于30-59岁年龄组(43.8%)，主要发生在男性。
结论：西部北方邦的结核病阳性率很高。北方邦西部耐多药结核病的负担与国家数据相似。正如本研究中所做的那样，线探针测定可用作诊断耐多药结核病的主要方法，这可以帮助更早地开始正确的治疗。
方法：在Meerut的三级保健医院进行了一项横断面前瞻性研究。根据RNTCP指南，从449名疑似肺结核患者中收集了898份痰样本（现场和清晨），通过显微镜进行了筛选。通过N-乙酰基-1-半胱氨酸和氢氧化钠进行去污。然后使用LPAGenoType®MTBDRplus（HAINLifeScience）测定法对涂片阳性样品进行一线药敏试验（DST），一种可以快速检测利福平（Rif）和异烟肼（INH）耐药性的分子方法。
结果：该地理区域耐多药结核病的总体负担为7.9％。单独使用Rif的单抗性约为2.8%。然而,INH（inhA基因）和INH（katG基因）的单抗性分别为2.8％和1.1％。Rif的耐药性是由于rpoB基因的突变，而对INH的耐药性更常见的是由于inhA基因的突变，然后是katG基因。结核病更常见于30-59岁年龄组(43.8%)，主要发生在男性。
结论：西部北方邦的结核病阳性率很高。北方邦西部耐多药结核病的负担与国家数据相似。正如本研究中所做的那样，线探针测定可用作诊断耐多药结核病的主要方法，这可以帮助更早地开始正确的治疗。
