耶氏肺孢子菌对磺胺类药物耐药相关基因突变的研究进展

肺孢子菌肺炎是由耶氏肺孢子菌引起的，发生在免疫功能低下人群中的机会性感染。大量证据表明，耶氏肺孢子菌对磺胺类药物耐药性增加与二氢叶酸合成酶（DHPS）基因和二氢叶酸还原酶（DHFR）基因突变有关，但具体机制尚不清楚。DHPS和DHFR基因突变增加可能是药物选择性压力所致，也可能是耶氏肺孢子菌基因多态性自然发展和传播的结果。本文对耶氏肺孢子菌DHPS和DHFR基因突变产生的原因、分子流行病学研究进展及其与临床结局的关系进行了综述。
Abstract: Pneumocystis jirovecii pneumonia is an opportunistic infection among immunocompromised people. Studies have found that the increased resistance to sulfa drugs of Pneumocystis jirovecii may be associated with the mutation of dihydropteroate synthase (DHPS) gene and dihydrofolate reductase (DHFR) genes, but the mechanism is still unclear. The mutation of DHPS and DHFR genes may be the result of sulfa drugs selection or spontaneous genetic polymorphism, and it can be acquired from person-to-person transmission. This article reviews the cause, molecular epidemiology of DHPS and DHFR gene mutation, and the relationship between DHPS and DHFR gene mutation and clinical outcomes. Key words: Drug resistance,bacterial/genetics Pneumonia,pneumocystis/physiopathology Tetrahydrofolate dehydrogenase Sulfonamides/pharmacology Genes Mutation Review