Gene Xpert MTB/RIF检测在复治肺结核诊治中的应用  

Application of Gene Xpert MTB/RIF in the Diagnosis and Treatment of Retreated Pulmonary Tuberculosis

作　　者：苏雯婕[1] 汤春梅[1] 王晓杰[1] 张言斌[1] SU Wenjie;WANG Xiaojie;TANG Chunmei;ZHANG Yanbin(Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院

出　　处：《现代医院》2020年第1期154-156,共3页Modern Hospitals

摘　　要：目的探讨利福平耐药实时荧光定量核酸扩增技术(Gene Xpert MTB/RIF)在复治肺结核诊断及治疗中的应用价值。方法回顾性分析2016年1月至2017年6月期间广州市胸科医院住院病人中238名疑似结核复发患者的Gene Xpert MTB/RIF、痰或支气管灌洗液培养及传统药敏试验、涂片结果,并进行对比分析。结果 238名患者中其中诊断为肺结核复发80例,非活动性肺结核158例,其中22例合并非结核分枝杆菌感染。应用Gene Xpert MTB/RIF诊断肺结核复发的敏感度为86. 25%,特异性为91. 12%,较传统涂片法有更高的敏感度。但特异性低于培养法,有8. 87%非活动性肺结核患者Xpert检测仍为阳性。63例结核培养阳性患者的药敏结果显示,Gene Xpert MTB/RIF检测利福平耐药性与传统药敏结果一致率达95. 31%,差异无统计学意义(P <0. 05),一致性比较Kappa值=0. 90。结论 Gene Xpert MTB/RIF作为判断结核复发诊断标准其敏感度优于涂片法,但存在假阳性及死菌干扰可能,作为单一确诊结核复发依据需谨慎。对于判断利福平耐药性与传统药敏试验效果相当,但检测过程更简单、快捷,有利于复治肺结核患者的早期发现及耐药性判断、指导治疗。Objective To explore the value of Gene Xpert MTB/RIF detection in the diagnosis and treatment of retreated pulmonary tuberculosis. Methods Gene Xpert MTB/RIF,sputum or bronchial lavage fluid culture,traditional drug sensitivity test and smear Results of 238 suspected retreated tuberculosis patients in Guangzhou Chest Hospital from January 2016 to June 2017 were retrospectively analyzed and compared. Results Of the 238 patients,80 were diagnosed as tuberculosis recurrence and 158 as inactive pulmonary tuberculosis,of which 22 were complicated with non-tuberculosis Mycobacterium infection. The sensitivity and specificity of Gene Xpert MTB/RIF in the diagnosis of tuberculosis recurrence were 86.25% and 91. 12%,which were higher than traditional smear method. However,the specificity was lower than that of culture method,and 8. 87% of patients with inactive pulmonary tuberculosis were still positive for Xpert test. The drug sensitivity of63 tuberculosis culture positive patients showed that the coincidence rate of rifampicin resistance detected by Gene Xpert MTB/RIF and traditional drug sensitivity was 95. 31%. There was no significant difference( P < 0. 05). The consistency of Kappa value was 0. 90. Conclusion Gene Xpert MTB/RIF is more sensitive than the smear method as a diagnostic criterion for tuberculosis recurrence,but there are possibilities of false positive and dead bacteria interference. It should be cautious to use Gene Xpert MTB/RIF as a basis for single diagnosis of tuberculosis recurrence. For judging rifampicin resistance and traditional drug sensitivity test,the effect is similar,but the detection process is simpler and faster,which is conducive to the early detection of retreated pulmonary tuberculosis patients and drug resistance judgment,guidance and treatment.

关 键 词：肺结核 复发 Gene Xpert MTB/RIF检测 诊断 应用 

分 类 号：R521[医药卫生—内科学]