利福平耐药实时荧光定量核酸扩增检测技术应用于儿童肺结核快速诊断的效果
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摘要
目的探讨利福平耐药实时荧光定量核酸扩增检测技术(XpertMTB/RIF)在快速诊断儿童肺结核中的应用价值。方法我院收治经临床诊断的120例肺结核患儿,采集肺泡灌洗液标本,分别行结核分枝杆菌罗氏培养、比例法药敏试验及XpertMTB/RIF检测。结果 120例灌洗液,罗氏培养显示,25例阳性,阳性率20. 83%(25/120); XpertMTB/RIF检测显示,74例阳性,阳性率61. 67%(74/120)。25例罗氏培养阳性的标本中,XpertMTB/RIF检测结核分枝杆菌阳性率为96. 00%(24/25),95例罗氏培养阴性标本中,XpertMTB/RIF检测结核分枝杆菌阳性率为52. 63%(50/95)。以比例法药敏试验结果为"金标准",XpertMTB/RIF检测利福平耐药的敏感度为100. 00%(3/3),特异度为95. 45%(21/22)。结论 XpertMTB/RIF可快速检测儿童肺泡灌洗液中结核分枝杆菌及利福平耐药情况,敏感度较高,对儿童肺结核诊疗有一定价值。
Objective To investigate the application value of Xpert mycobacterium tuberculosis/rifampicin( Xpert MTB/RIF in the rapid diagnosis of child pulmonary tuberculosis. Methods One hundred and twenty children with pulmonary tuberculosis who were admitted to our hospital were enrolled in the study.The bronchoalveolar lavage fluid( BALF) specimens of all subjects were collected for Lowenstein-Jensen cultures of mycobacterium tuberculosis and drug sensitivity test by using proportion sensitivity method and Xpert MTB/RIF detection.Results Lowenstein-Jensen cultures of BALF showed that the positive rate was 20. 83%( 25/120) while Xpert MTB/RIF detection showed the positive rate was 61. 67%( 74/120).The positive rate of mycobacterium tuberculosis detected by Xpert MTB/RIF detection in 25 cases of Lowenstein-Jensen culture positive specimens was 96. 00%( 24/25) while the positive rate in95 cases of Lowenstein-Jensen culture negative specimens was 52. 63%( 50/95).The sensitivity and specificity of Xpert MTB/RIF detection for rifampin resistance were 100. 00%( 3/3) and 95. 45%( 21/22),respectively,when results of drug sensitivity test by proportion sensitivity method were taken as the golden standard.Conclusion Xpert MTB/RIF can quickly detect mycobacterium tuberculosis in BALF and rifampicin resistance in children with high sensitivity.It is of certain value in diagnosis and treatment of pulmonary tuberculosis in children.
Objective To investigate the application value of Xpert mycobacterium tuberculosis/rifampicin( Xpert MTB/RIF in the rapid diagnosis of child pulmonary tuberculosis. Methods One hundred and twenty children with pulmonary tuberculosis who were admitted to our hospital were enrolled in the study.The bronchoalveolar lavage fluid( BALF) specimens of all subjects were collected for Lowenstein-Jensen cultures of mycobacterium tuberculosis and drug sensitivity test by using proportion sensitivity method and Xpert MTB/RIF detection.Results Lowenstein-Jensen cultures of BALF showed that the positive rate was 20. 83%( 25/120) while Xpert MTB/RIF detection showed the positive rate was 61. 67%( 74/120).The positive rate of mycobacterium tuberculosis detected by Xpert MTB/RIF detection in 25 cases of Lowenstein-Jensen culture positive specimens was 96. 00%( 24/25) while the positive rate in95 cases of Lowenstein-Jensen culture negative specimens was 52. 63%( 50/95).The sensitivity and specificity of Xpert MTB/RIF detection for rifampin resistance were 100. 00%( 3/3) and 95. 45%( 21/22),respectively,when results of drug sensitivity test by proportion sensitivity method were taken as the golden standard.Conclusion Xpert MTB/RIF can quickly detect mycobacterium tuberculosis in BALF and rifampicin resistance in children with high sensitivity.It is of certain value in diagnosis and treatment of pulmonary tuberculosis in children.
引文
[1]黄培生,余复火,刘桂芬.对氨基水杨酸异烟肼联合左氧氟沙星治疗复治菌阳尘肺结核临床疗效研究[J].实用心脑肺血管病杂志,2015,12(3):25-26.
[2]Quynh NNT,Minh HDT,Nguyen A,et al.Evaluation of Xpert MTB/RIF and MODS assay for the diagnosis of pediatric tuberculosis[J].BMC Infectious Diseases,2013,13(1):31-35.
[3]Chisti MJ,Graham SM,Duke T,et al. A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay[J].Plos One,2014,9(4):e93776-e93779.
[4]Kayigire XA,Friedrich SO,Venter A,et al. Direct Comparison of Xpert MTB/RIF Assay with Liquid and Solid Mycobacterial Culture for Quantification of Early Bactericidal Activity[J]. Journal of Clinical Microbiology,2013,51(6):1894-1898.
[5]高孟秋.《WS288-2017肺结核诊断》新标准中关于临床诊断患者判定的解析[J].中国防痨杂志,2018,40(3):243-246.
[6]李栋立,钱福初,秦基取,等.儿童肺结核病实验室诊断方法的建立及应用评价[J].中国卫生检验杂志,2017,27(21):3132-3134.
[7]覃慧芳,林玫,崔哲哲,等.液体MGIT培养与改良罗氏培养方法在HIV感染与AIDS患者结核病筛查中的对比研究[J].中国防痨杂志,2016,38(10):832-837.
[8]张伟.基因芯片与传统罗氏培养检测结核分支杆菌药敏结果分析[J].安徽医学,2015,36(12):1527-1529.
[9]张海晴,黄海滨,王春颖,等.RNA恒温扩增实时荧光检测技术在检测脑脊液中结核分枝杆菌的应用[J].广东医学,2017,38(11):1715-1716.
[10]张爱梅,李锋,刘旭晖,等.利福平耐药实时荧光定量核酸扩增技术在儿童结核病快速检测中的应用[J].中华儿科杂志,2016,54(5):370-374.
[11]何贵清,李涛,施伎蝉,等.利福平耐药结核分枝杆菌实时荧光定量核酸扩增检测技术在214例诊断肺结核患者中的临床应用评价[J].中华传染病杂志,2016,34(6):349-353.
[12]周林,夏强,谢文君,等.半巢式全自动实时荧光定量核酸扩增技术在淋巴结结核快速诊断中的应用[J].中华临床感染病杂志,2016,9(6):502-506.
[13]Edita P,Rolandas Z,Vladyslav N,et al.The Xpert MTB/RIF assay in routine diagnosis of pulmonary tuberculosis:A multicentre study in Lithuania[J].Respiratory Medicine,2015,109(11):1484-1489.
[14]路丽苹,陆斌,刘梅,等.GeneXpert MTB/RIF技术在结核病早诊断中的应用[J].中国防痨杂志,2017,39(1):71-75.
[15]Ling DI,Nicol MP,Madhukar P,et al.Incremental value of T-SPOT.TBfor diagnosis of active pulmonary tuberculosis in children in a high-burden setting:a multivariable analysis[J]. Thorax,2013,68(9):860-866.
[16]Scott LE,Beylis N,Nicol M,et al. Diagnostic accuracy of Xpert MTB/RIF for extrapulmonary tuberculosis specimens:establishing a laboratory testing algorithm for South Africa.[J]. Journal of Clinical Microbiology,2014,52(6):1818-1823.
[2]Quynh NNT,Minh HDT,Nguyen A,et al.Evaluation of Xpert MTB/RIF and MODS assay for the diagnosis of pediatric tuberculosis[J].BMC Infectious Diseases,2013,13(1):31-35.
[3]Chisti MJ,Graham SM,Duke T,et al. A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay[J].Plos One,2014,9(4):e93776-e93779.
[4]Kayigire XA,Friedrich SO,Venter A,et al. Direct Comparison of Xpert MTB/RIF Assay with Liquid and Solid Mycobacterial Culture for Quantification of Early Bactericidal Activity[J]. Journal of Clinical Microbiology,2013,51(6):1894-1898.
[5]高孟秋.《WS288-2017肺结核诊断》新标准中关于临床诊断患者判定的解析[J].中国防痨杂志,2018,40(3):243-246.
[6]李栋立,钱福初,秦基取,等.儿童肺结核病实验室诊断方法的建立及应用评价[J].中国卫生检验杂志,2017,27(21):3132-3134.
[7]覃慧芳,林玫,崔哲哲,等.液体MGIT培养与改良罗氏培养方法在HIV感染与AIDS患者结核病筛查中的对比研究[J].中国防痨杂志,2016,38(10):832-837.
[8]张伟.基因芯片与传统罗氏培养检测结核分支杆菌药敏结果分析[J].安徽医学,2015,36(12):1527-1529.
[9]张海晴,黄海滨,王春颖,等.RNA恒温扩增实时荧光检测技术在检测脑脊液中结核分枝杆菌的应用[J].广东医学,2017,38(11):1715-1716.
[10]张爱梅,李锋,刘旭晖,等.利福平耐药实时荧光定量核酸扩增技术在儿童结核病快速检测中的应用[J].中华儿科杂志,2016,54(5):370-374.
[11]何贵清,李涛,施伎蝉,等.利福平耐药结核分枝杆菌实时荧光定量核酸扩增检测技术在214例诊断肺结核患者中的临床应用评价[J].中华传染病杂志,2016,34(6):349-353.
[12]周林,夏强,谢文君,等.半巢式全自动实时荧光定量核酸扩增技术在淋巴结结核快速诊断中的应用[J].中华临床感染病杂志,2016,9(6):502-506.
[13]Edita P,Rolandas Z,Vladyslav N,et al.The Xpert MTB/RIF assay in routine diagnosis of pulmonary tuberculosis:A multicentre study in Lithuania[J].Respiratory Medicine,2015,109(11):1484-1489.
[14]路丽苹,陆斌,刘梅,等.GeneXpert MTB/RIF技术在结核病早诊断中的应用[J].中国防痨杂志,2017,39(1):71-75.
[15]Ling DI,Nicol MP,Madhukar P,et al.Incremental value of T-SPOT.TBfor diagnosis of active pulmonary tuberculosis in children in a high-burden setting:a multivariable analysis[J]. Thorax,2013,68(9):860-866.
[16]Scott LE,Beylis N,Nicol M,et al. Diagnostic accuracy of Xpert MTB/RIF for extrapulmonary tuberculosis specimens:establishing a laboratory testing algorithm for South Africa.[J]. Journal of Clinical Microbiology,2014,52(6):1818-1823.