结核分枝杆菌吡嗪酰胺耐药性检测方法的研究进展

Testing of the susceptibility of Mycobacterium tuberculosis to pyrazinamide

摘要:

吡嗪酰胺(pyrazinamide，PZA)是重要的一线抗结核药物，与异烟肼、利福平和乙胺丁醇构成治疗方案的核心。因其疗效较好，被广泛应用于结核病的治疗过程。然而，近年来随着耐多药结核病的出现，PZA耐药导致部分患者治疗失败，因此常规开展PZA药物敏感性试验对于减少耐药性的发生显得极为重要。由于PZA在酸性条件下才能发挥作用，而结核分枝杆菌在酸性环境下生长不良，故PZA耐药性检测一直是临床中的难题。本文结合国内外最新研究进展，就结核分枝杆菌PZA耐药性检测方法的研究进行阐述，期望能为更有效地诊治结核病提供新思路。

Abstract:

Pyrazinamide (PZA) is an indispensable first-line drug for the treatment of tuberculosis. It plays a key role in shortening the course of the treatment from 9–12 months to 6 months. The antibiotics rifampicin (R), isoniazid (H), ethambutol (E), and PZA (Z) form the core control regimen for the drug-sensitive Mycobacterium tuberculosis. However, PZA resistance has led to treatment failure in many patients with the emergence of MDR-TB in recent years. Therefore, it is particularly important for reducing PZA resistance to carry out the susceptibility test. Nevertheless, the test is challenging and often unreliable, as the drug is active only at pH 5.5 which affects the in vitro growth of M. tuberculosis, and thus causes both false-susceptible and false-resistant results. In this review, we summarized the research on susceptibility testing of PZA, hoping to provide a reference for the effective diagnosis and treatment of tuberculosis.