Gene-XpertMTB/RIF技术在HIV合并结核分枝杆菌感染筛查中的应用
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摘要
目的探讨新技术(Gene-Xpert MTB/RIF,简称为Xpert)在人类免疫缺陷病毒(HIV)合并结核分枝杆菌感染筛查中的临床应用,期望为HIV/TB的感染者找到快捷、准确的检测方法或者检测方法组合。方法收集云南省传染病医院2017年3月至2018年12月收治的HIV住院患者278例痰液标本,每例患者痰液标本均用Xpert、罗氏培养法和直接涂片萋-纳抗酸染色法三种方法进行检测。结果 Xpert、罗氏培养和直接涂片萋-纳抗酸染色法三种检测方法的阳性率分别为15.8%、12.6%、10.8%,Xpert与其他两种方法一致性评价,均为Kappa>0.75,一致性较好。结论 Gene-Xpert MTB/RIF技术是一种快速、安全、高效的分子生物学检测方法,并且能够同时检测利福平的耐药性,对艾滋病合并结核病的早期筛查具有重要意义。
Objective To explore the clinical application of new technique(Gene-Xpert MTB/RIF short for "Xpert") in the screening of Mycobacterium tuberculosis infection in HIV patients, in order to find a quick and accurate detection method or combination method for the infected persons with HIV/TB. Methods Sputum samples of HIV patients were collected from March 2017 to December 2018 in Yunnan Infectious Diseases Hospital. Sputum samples of each patient were detected by Xpert, Roche culture method, and direct smear of acid-fast staining method. Results The positive rate was 15.8%, 12.6%, 10.8% respectively by Xpert, Roche culture, and direct smear of acid-fast staining. The results showed that Xpert was in good concordance with the other two methods(Kappa>0.75). Conclusion Gene-Xpert MTB/RIF is a rapid,safe, and efficient molecular biological detection method, which can detect rifampicin resistance at the same time. It is of great significance for early screening of HIV/AIDS co-infection with tuberculosis.
Objective To explore the clinical application of new technique(Gene-Xpert MTB/RIF short for "Xpert") in the screening of Mycobacterium tuberculosis infection in HIV patients, in order to find a quick and accurate detection method or combination method for the infected persons with HIV/TB. Methods Sputum samples of HIV patients were collected from March 2017 to December 2018 in Yunnan Infectious Diseases Hospital. Sputum samples of each patient were detected by Xpert, Roche culture method, and direct smear of acid-fast staining method. Results The positive rate was 15.8%, 12.6%, 10.8% respectively by Xpert, Roche culture, and direct smear of acid-fast staining. The results showed that Xpert was in good concordance with the other two methods(Kappa>0.75). Conclusion Gene-Xpert MTB/RIF is a rapid,safe, and efficient molecular biological detection method, which can detect rifampicin resistance at the same time. It is of great significance for early screening of HIV/AIDS co-infection with tuberculosis.
引文
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[9] CHIANG TY, FAN SY, JOU R. Performance of an Xpert-based diagnostic algorithm for the rapid detection of drug resistant tuberculosis among high-risk populations in a low-incidence setting[J]. PLoS One, 2018, 13(7):e0200755(1-14).
[10]彭远远,王庆,徐东芳. 3种分子检测技术在结核病实验室诊断中的应用评价[J].中国社区医师, 2018, 34(31):97, 99.
[11]刘旭晖,张爱梅,卢水华. Xpert MTB/RIF试验用于肺结核快速检测的临床研究[J].中华肺部疾病杂志(电子版), 2016, 9(5):524-527.
[12]樊红丽,李健健,高丽,等. 3种检测方法在HIV合并结核分枝杆菌感染诊断中的对比研究[J].检验医学与临床, 2017, 14(3):392-395.
[13]结核分枝杆菌rpoB基因和突变检测试剂盒(实时荧光PCR)说明书,美国sunny valley赛沛, 301-3300C,修订版G, 2018年8月.
[14]赵永,梁庆福,林淑芳,等. XpertMTB/RIF检测技术用于耐多药结核分枝杆菌利福平耐药检测分析[J].中国卫生检验杂志, 2015, 25(15):2621-2622, 2628.
[15] AKANBI MO, ACHENBACH C, TAIWO B, et al. Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria:a propective cohort study[J]. BMC Pulm Med, 2017, 17(1):87.
[16] REDDY R, ALVAREZ-URIA G. Molecular epidemiology of Rifampicin resistance in Mycobacterium tuberculosis using the GeneXpert MTB/RIF assay from a rural setting in India[J]. J Pathog, 2017:6738095(1-5).doi:10.1155/2017/6738095.Epub 2017 Oct 26
[17] SHRESTHA P, KHANAL H, DAHAL P, et al. Programmatic impact of implementing GeneXpert MTB/RIF assay for the detection of Mycobacterium Tuberculosis in respiratory specimens from pulmonary tuberculosis suspected patients in resource limited laboratory settings of eastern Nepal[J]. Open Microbiol J, 2018, 12:9-17.
[18]李娜娜,刘权贤,王鸿,等. Gene-XpertMTB/RIF技术诊断肺结核的效果评价[J].世界最新医学信息文摘(电子版), 2018, 18(64):125-126.
[19]张桂仙,高丽,谢祺,等.基因芯片检测技术在结核病诊断中的应用价值[J].海南医学, 2019, 30(2):193-196.
[20]陈军,陈丽峰,饶有益,等. Gene-Xpert MTB/RIF试验与4种结核分枝杆菌检测方法的比较[J].临床血液学杂志, 2018, 31(12):956-959.
[2]舒占钧,艾合买提·阿不都热依木,黄刚,等.中医温病理论在治疗艾滋病合并结核中的应用[J].世界科学技术:中医药现代化, 2013,15(5):872-876.
[3]王旭东,聂恒,吴利先.合并HIV感染肺结核患者Mtb的MLVA与PFGE法基因分型对比研究[J].中国病原生物学杂志, 2015, 10(12):1082-1085, 1096.
[4]郝贤斌,吴利先.人类免疫缺陷病毒与结核分枝杆菌双重感染的研究进展[J].中国病原生物学杂志, 2016, 11(4):374-376.
[5]张贺秋,赵雁林.现代结核病诊断技术[M].北京:人民卫生出版社,2013:215-216.
[6] METCALFE JZ, MAKUMBIROFA S, MAKAMURE B, et al. Xpert MTB/RIF detection of rifampin resistance and time to treatment initiation in Harare, Zimbabwe[J]. Int J Tuberc Lung Dis, 2016, 20(7):882-889.
[7] TANQ T, LIU F, LU XL, et al. Evaluation of GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis in a hospital in China[J].Journal of International Medical Research, 2017, 45(2):816-822.
[8] METAFERIA Y, SEID A, FENTA GM, et al. Assessment of extrapulmonary tuberculosis using gene Xpert MTB/RIF assay and fluorescent microscopy and its risk factors at dessie referral hospital, northeast Ethiopia[J]. Biomed Res Int, 2018, 7:8207098.
[9] CHIANG TY, FAN SY, JOU R. Performance of an Xpert-based diagnostic algorithm for the rapid detection of drug resistant tuberculosis among high-risk populations in a low-incidence setting[J]. PLoS One, 2018, 13(7):e0200755(1-14).
[10]彭远远,王庆,徐东芳. 3种分子检测技术在结核病实验室诊断中的应用评价[J].中国社区医师, 2018, 34(31):97, 99.
[11]刘旭晖,张爱梅,卢水华. Xpert MTB/RIF试验用于肺结核快速检测的临床研究[J].中华肺部疾病杂志(电子版), 2016, 9(5):524-527.
[12]樊红丽,李健健,高丽,等. 3种检测方法在HIV合并结核分枝杆菌感染诊断中的对比研究[J].检验医学与临床, 2017, 14(3):392-395.
[13]结核分枝杆菌rpoB基因和突变检测试剂盒(实时荧光PCR)说明书,美国sunny valley赛沛, 301-3300C,修订版G, 2018年8月.
[14]赵永,梁庆福,林淑芳,等. XpertMTB/RIF检测技术用于耐多药结核分枝杆菌利福平耐药检测分析[J].中国卫生检验杂志, 2015, 25(15):2621-2622, 2628.
[15] AKANBI MO, ACHENBACH C, TAIWO B, et al. Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria:a propective cohort study[J]. BMC Pulm Med, 2017, 17(1):87.
[16] REDDY R, ALVAREZ-URIA G. Molecular epidemiology of Rifampicin resistance in Mycobacterium tuberculosis using the GeneXpert MTB/RIF assay from a rural setting in India[J]. J Pathog, 2017:6738095(1-5).doi:10.1155/2017/6738095.Epub 2017 Oct 26
[17] SHRESTHA P, KHANAL H, DAHAL P, et al. Programmatic impact of implementing GeneXpert MTB/RIF assay for the detection of Mycobacterium Tuberculosis in respiratory specimens from pulmonary tuberculosis suspected patients in resource limited laboratory settings of eastern Nepal[J]. Open Microbiol J, 2018, 12:9-17.
[18]李娜娜,刘权贤,王鸿,等. Gene-XpertMTB/RIF技术诊断肺结核的效果评价[J].世界最新医学信息文摘(电子版), 2018, 18(64):125-126.
[19]张桂仙,高丽,谢祺,等.基因芯片检测技术在结核病诊断中的应用价值[J].海南医学, 2019, 30(2):193-196.
[20]陈军,陈丽峰,饶有益,等. Gene-Xpert MTB/RIF试验与4种结核分枝杆菌检测方法的比较[J].临床血液学杂志, 2018, 31(12):956-959.