液体MGIT培养联合XpertMTB／RIF快速检测结核分枝杆菌及其耐药性的研究  

Combination of MGIT liquid culture and Xpert MTB/RIF test in the rapid diagnosis and drug resistance detection in Mycobacterium tuberculosis

作　　者：徐礼锋[1] 余旭良[1] 张峰[1] 水婷 陈娟[1] 祝进[1] 

机构地区：[1]浙江省衢州市人民医院检验科,324000

出　　处：《中华检验医学杂志》2016年第4期272-276,共5页Chinese Journal of Laboratory Medicine

基　　金：浙江省自然科学基金（LY13H200004）;衢州市科技计划项目（2014159）

摘　　要：目的评估液体分枝杆菌培养管（MGIT）培养法联合结核分枝杆菌利福平耐药实时荧光定量PCR试验（XpertMTB／RIF）在肺结核诊断中应用价值。方法方法学比对研究。2014年10月至2015年3月就诊衢州市人民医院的临床疑似肺结核患者652例，每例患者留取晨痰标本分别进行抗酸染色镜检、固体罗氏（L—J）培养、BACTECMGIT培养和XpertMTB／RIF检测，培养阳性标本进行菌种鉴定和液体法药物敏感试验。分析MGIT培养联合XpertMTB／RIF试验在检测结核分枝杆菌和耐药性中的效能，采用）（。检验对4种检测方法的敏感度进行比较。结果确诊为肺结核的399例患者中，4种方法敏感度分别为涂片镜检17．0％（68／399）、L-J培养23．8％（95／399）、MGIT培养37．8％（151／399）、XpertMTB／RIF37．3％（149／399），MGIT培养联合XpertMTB／RIF试验的敏感度为39．8％（159／399），特异度为94．8％（240／253）。MGIT培养联合XpertMTB／RIF检测敏感度高于涂片镜检（x2=50．9，P〈0．01）和固体L—J培养（x2=23．7，P〈0．01）。痰液标本MGIT培养平均时间分别为7．5d（涂片阳性、XpertMTB／RIF阳性）、13．4d（涂片阴性、XpertMTB／RIF阳性）和16．9d（涂片阴性、XpertMTB／RIF阴性）。XpertMTB／RIF检测利福平耐药的敏感度和特异度分别为9／9和97．3％（129／132），液体法药敏的平均耗时为8．3d。结论MGIT培养法联合xpertMTB／RIF能快速检测痰液中结核分枝杆菌及耐药性，该方法具有较高的敏感度和特异度，对肺结核和耐药性肺结核的诊断和治疗具有重要的临床应用价值。Objective To evaluate the feasibility of Mycobacteria growth indicator tube （MGIT） liquid culture combined with rifampin resistance test real-time PCR （Xpert MTB/R1F test） in the diagnosis of tuberculosis. Methods 652 cases of suspected pulmonary tuberculosis from October 2014 to March 2015 in Quzhou People＇s Hospital were enrolled. The morning sputum samples were collected for acid-fast staining, Lowenstein-Jensen （L-J） culture, BACTEC MGIT culture and Xpert MTB/RIF test. Samples with positive results of MGIT liquid culture were subjected to strain identification and drug sensitivity test with fluid method. Methodological comparison between four methods was made and the performance of MGIT liquid culture combined with Xpert MTB/RIF test in the rapid diagnosis and drug resistance detection in Mycobacterium tuberculosis was evaluated by chi-square test. Results Among the samples from 399 confirmed tuberculosis patients, the diagnostic sensitivity of the 4 methods （ acid-fast staining, L-J culture, MGIT culture and Xpert MTB/RIF test） were 17.0% （68/399）, 23.8% （95/399）, 37.8% （151/399） and 37.3% （149/399） respectively. The sensitivity and specificity of MGIT culture combined with Xpert MTB/RIF test was 39. 8% （159/399） and 94. 8% （240/253）. The sensitivity of MGIT culture combined with Xpert MTB/RIF test was significantly higher than acid-fast staining （ X2 = 50. 9, P 〈 0. 01 ） and L-J culture （X2 =23.7 ,P 〈0. 01 ）. The average detection time of MGIT culture was 7.5 days （smear positive and Xpert MTB/RIF positive）, 13. g days （smear negative and Xpert MTB/RIF positive） and 16.9 days （smear negative and Xpert MTB/RIF negative）. The sensitivity and specificity of Xpert MTB/RIF test in rifampin resistance detection were 9/9 and 97.3% （129/132） respectively. The average detection time of fluid method for drug sensitivity test was 8. 3 days. Conclusions MGIT liquid culture combined with Xpert MTB/RIF test can detect Mycobacterium tuberculosis and the

关 键 词：分枝杆菌 结核 利福平 结核 抗多种药物性 聚合酶链反应 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学] R521[医药卫生—临床医学]