Xpert MTB/RIF检测痰标本结核分枝杆菌与利福平耐受性的临床应用研究
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摘要
目的分析Xpert MTB/RIF方法用于临床快速检测结核分枝杆菌(MTB)与利福平耐受性的临床意义。方法收集2015年1-12月在惠州市结核病防治研究所及5个县区医院结核科就诊的肺结核患者痰标本552例,进行涂片镜检、Xpert MTB/RIF核酸检测和改良罗氏培养,并对培养阳性者进行药敏实验。评价各种方法 MTB检测灵敏度与特异度,对比传统药敏方法和Xpert MTB/RIF检测利福平耐药性的结果并分析。结果 Xpert MTB/RIF与改良罗氏培养法对MTB检测结果相比,敏感度95.3%、特异度93.1%;耐药性对比结果中,所有阳性标本中利福平耐药的敏感度82.1%,特异度97.8%;Xpert MTB/RIF检测MTB分级与改良罗氏培养分级一致性分析中,kappa=0.688,提示两者结果具有良好的一致性。结论 Xpert MTB/RIF可用于临床早期快速检测结核分枝杆菌与利福平耐药检测的筛查,有利于临床快速决策。
Objective To analyzer the clinical significance of the Xpert MTB/RIF method for rapidly detecting Mycobacterium tuberculosis(MTB)and rifampicin resistance in clinic.Methods A total of 552 sputum samples were collected from the patients in the Huizhou Municipal Institute of Tuberculosis Prevention and Control and tuberculosis departments in 5counties and districts from January 2015 to December 2015.Smear microscopic examination,Xpert MTB/RIF nucleic acid detection and improved Roche culture were performed.The samples of culture positive were performed the drug susceptibility test.The sensitivity,specificity of various methods for detecting MTB were evaluated.The results of conventional susceptibility test and Xpert MTB/RIF for detecting rifampicin resistance were compared and analyzed.Results Compared with the Roche culture method,the sensitivity and specificity of Xpert MTB/RIF for detecting MTB were 95.3% and 93.1%.In the comparison of drug resistance detection results,the sensitivity and specificity of rifampicin resistance in all positive samples were 82.1% and 97.8%.In the consistency analysis of Xpert MTB/RIF and improved Roche culture for detecting MTB classification,kappa=0.688,indicating that the results of the two methods had good consistency.Conclusion The Xpert MTB/RIF method can be used in MTB early rapid detection and screening of rifampicin resistance detection,which is conducive to clinical rapid decision.
Objective To analyzer the clinical significance of the Xpert MTB/RIF method for rapidly detecting Mycobacterium tuberculosis(MTB)and rifampicin resistance in clinic.Methods A total of 552 sputum samples were collected from the patients in the Huizhou Municipal Institute of Tuberculosis Prevention and Control and tuberculosis departments in 5counties and districts from January 2015 to December 2015.Smear microscopic examination,Xpert MTB/RIF nucleic acid detection and improved Roche culture were performed.The samples of culture positive were performed the drug susceptibility test.The sensitivity,specificity of various methods for detecting MTB were evaluated.The results of conventional susceptibility test and Xpert MTB/RIF for detecting rifampicin resistance were compared and analyzed.Results Compared with the Roche culture method,the sensitivity and specificity of Xpert MTB/RIF for detecting MTB were 95.3% and 93.1%.In the comparison of drug resistance detection results,the sensitivity and specificity of rifampicin resistance in all positive samples were 82.1% and 97.8%.In the consistency analysis of Xpert MTB/RIF and improved Roche culture for detecting MTB classification,kappa=0.688,indicating that the results of the two methods had good consistency.Conclusion The Xpert MTB/RIF method can be used in MTB early rapid detection and screening of rifampicin resistance detection,which is conducive to clinical rapid decision.
引文
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[6]Metcalfe JZ,Makumbirofa S,Makamure B,et al.Xpert(R)MTB/RIF detection of rifampin resistance and time to treatment initiation in Harare,Zimbabwe[J].Inter J Tube Dis,2016,20(7):882-889.
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[8]路晓红,付玉荣,伊正君.基于核酸检测诊断结核分枝杆菌感染的研究进展[J].中国人兽共患病学报,2015,10(10):967-971.
[9]陈钰,罗力涵,张波.新型结核分枝杆菌快速检测技术研究进展[J].中国国境卫生检疫杂志,2016,25(4):373-375.
[2]杨慧娟,马利,陈连勇,等.Xpert MTB/RIF技术对结核分枝杆菌检测和耐多药结核快速筛查的研究[J].中国卫生检验杂志,2015,23(3):4056-4059.
[3]Luetkemeyer AF,Firnhaber C,Kendall MA,et al.Evaluation of xpert MTB/RIF versus AFB smear and culture to identify pulmonary tuberculosis in patients with suspected tuberculosis from low and higher prevalence settings[J].Clin Infect Dis,2016,62(9):1081-1088.
[4]曾松芳,郭美丽,赵珊珊,等.结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术在肺结核快速诊断中的应用价值[J].中国卫生检验杂志,2016,30(5):683-685.
[5]李妍,张天华,鲜小萍,等.利用Xpert MTB/RIF检测结核分枝杆菌及利福平耐药性的研究[J].临床肺科杂志,2016,21(10):1762-1765.
[6]Metcalfe JZ,Makumbirofa S,Makamure B,et al.Xpert(R)MTB/RIF detection of rifampin resistance and time to treatment initiation in Harare,Zimbabwe[J].Inter J Tube Dis,2016,20(7):882-889.
[7]田斌,王孝君,文岚.Xpert MTB/RIF检测系统对肺结核临床诊断病例的应用价值[J].中国人兽共患病学报,2016,20(9):798-801.
[8]路晓红,付玉荣,伊正君.基于核酸检测诊断结核分枝杆菌感染的研究进展[J].中国人兽共患病学报,2015,10(10):967-971.
[9]陈钰,罗力涵,张波.新型结核分枝杆菌快速检测技术研究进展[J].中国国境卫生检疫杂志,2016,25(4):373-375.