荧光PCR溶解曲线法检测结核分枝杆菌氟喹诺酮类药物突变的临床应用价值  

Clinical application value of fluorescence PCR fusion curve in detecting fluoroquinolone drug mutation in mycobacterium tuberculosis patients

作　　者：邹远妩 王婷[2] 李王平 ZOU Yuan-wu;WANG Ting;LI Wang-ping(Department of Laboratory,Tuberculosis Control Hospital of Shaanxi Province,XI'an,Shaanxi 710100,China;Department of Nuclear Medicine,Ankang Central Hospital,Ankang,Shaanxi 725000,China;Department of Respiratory,Tangdu Hospital Affiliated to Air Force Medical University,XI'an,Shannxi 710038,China)

机构地区：[1]陕西省结核病防治院检验科,陕西西安710100 [2]安康市中心医院核医学科,陕西安康725000 [3]空军军医大学唐都医院,陕西西安710038

出　　处：《临床肺科杂志》2020年第7期1027-1029,共3页Journal of Clinical Pulmonary Medicine

基　　金：陕西省重点研发项目(No.2017SF-052)。

摘　　要：目的评估荧光PCR溶解曲线法诊断氟喹诺酮类药物耐药结核病的价值。方法用罗氏药敏法与溶解曲线法同时检测555株结核分枝杆菌临床分离株对氟喹诺酮类药物中左氧氟沙星(Levofloxacin,LFX)和莫西沙星(Moxifloxacin,MFX)的耐药突变,并进行分析比较。结果罗氏药敏法与溶解曲线法检测LFX、MFX耐药性差异均具有统计学意义(P<0.05))。以罗氏药敏为标准,溶解曲线法检测左氧氟沙星耐药突变敏感度、特异度、阳性预测值、阴性预测值、约登指数、符合率分别为85.37%(35/41),93.58%(481/514),51.47%(35/68)、98.76%(481/487)0.79,92.97%;溶解曲线法检测莫西沙星耐药突变敏感度、特异度、阳性预测值、阴性预测值、约登指数、符合率分别为84.38%(27/32),92.16%(482/523),39.71%(27/68),98.97%(482/487),0.77,91.97%。结论溶解曲线法检测结核分枝杆菌氟喹诺酮类药物突变敏感度、特异度较高、快速;有利于耐药结核病快速诊断和治疗。Objective To evaluate the diagnostic value of fluorescence PCR fusion curve method for fluoroquinolones resistant mutations in mycobacterium tuberculosis.Methods The drug resistance mutations of 555 mycobacterium tuberculosis isolates to Levofloxacin(LFX)and MoxifLoxacin(MFX)in fluoroquinolones were detected and compared by Roche's traditional ratio susceptibility and melting curve method.Results The difference of drug resistance between levofloxacin and moxifloxacin was statistically significant(P<0.05).For the same strain,the sensitivity,specificity,positive predictive value,negative predictive value,approximately equal index and coincidence rate of LFX mutation resistance detected by the fusion curve method were 85.37%(35/41),93.58%(481/514),51.47%(35/68),98.76%(481/487),0.79,and 92.97%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,approximately equal index and coincidence rate of MFX were 84.38%(27/32),92.16%(482/523),39.71%(27/68),98.97%(482/487),0.77,and 91.97%,respectively.Conclusion The fusion curve method can significantly shorten the diagnosis and treatment time of mycobacterium tuberculosis,which has a good guiding significance in diagnosis and treatment of drug-resistant tuberculosis.

关 键 词：结核分枝杆菌 耐药结核病 氟喹诺酮类药物 溶解曲线法 耐药突变 

分 类 号：R446.5[医药卫生—诊断学]