Xpert MTB/RIF技术在结核分枝杆菌利福平耐药性快速检测中的价值  

Role of Xpert MTB/RIF system in the rapid detection of Mycobacterium tuberculosis and rifampicin resistance

作　　者：刘军[1] 刘涛[1] 戴碗琴 王艺翔 侯彦强[1] LIU Jun;LIU Tao;DAI Wanqin;WANG Yixiang;HOU Yanqiang(Department of Clinical Laboratory,the Central Hospital of Songjiang,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院检验科,上海201600

出　　处：《检验医学》2020年第9期920-923,共4页Laboratory Medicine

基　　金：上海市松江区科学技术攻关项目(16SJGG27)。

摘　　要：目的探讨Xpert MTB/RIF技术在结核分枝杆菌(MTB)快速检测及利福平耐药检测中的价值。方法收集1562例初诊疑似肺结核患者痰液样本,同时采用Xpert MTB/RIF法、液体培养法和涂片抗酸染色法进行检测,评价Xpert MTB/RIF法的检测敏感性和特异性。以液体培养法为标准,分析Xpert MTB/RIF法检测涂片抗酸染色法阳性、阴性标本的敏感性和特异性。将188例液体培养阳性样本进行分枝杆菌菌群鉴定和药物敏感性试验,评价Xpert MTB/RIF法检测MTB及其对利福平耐药的敏感性和特异性。结果Xpert MTB/RIF法与液体培养法检测结果的符合率为93.92%(χ2=3.55,P>0.05),与涂片抗酸染色法的符合率为89.44%(χ2=48.51,P<0.001)。以液体培养法为标准,Xpert MTB/RIF法的检测敏感性为82.41%(328/398)、特异性为97.85%(1139/1164),2种方法差异无统计学意义(χ2=3.55,P>0.05);Xpert MTB/RIF法鉴定188例液体培养阳性样本菌群种类的敏感性为91.23%(156/171)、特异性为88.24%(15/17)、准确性为90.96%(171/188),与液体培养法比较差异无统计学意义(χ2=4.109,P>0.05);Xpert MTB/RIF法检测利福平耐药的敏感性为82.35%(14/17)、特异性为99.35%(1/154),与传统比例法药物敏感性试验结果比较,差异无统计学意义(χ2=0.138,P>0.05)。结论Xpert MTB/RIF技术可快速检测MTB及其对利福平的耐药性,敏感性和特异性较好,具有较高的临床应用价值。Objective To investigate the role of Xpert MTB/RIF system in the rapid detection of Mycobacterium tuberculosis(MTB)and rifampicin resistance.Methods The sputum samples of 1562 suspected tuberculosis patients were collected,and were determined by Xpert MTB/RIF,liquid culture and acid resistance staining method.The sensitivity and specificity of Xpert MTB/RIF for detecting acid resistance staining positive samples were analyzed using liquid culture method as the standard.The identification and the drug susceptibility test were carried out on 188 cases of positive liquid culture samples to evaluate the sensitivity and specificity of the detection of MTB and rifampicin resistance by Xpert MTB/RIF.Results The consistency rate of Xpert MTB/RIF with liquid culture was 93.92%(χ2=3.55,P>0.05).That with smear method was 89.44%(χ2=48.51,P<0.001).The sensitivity of Xpert MTB/RIF was 82.41%(328/398),and the specificity was 97.85%(1139/1164),using liquid culture as a standard,with no statistical significance between Xpert MTB/RIF and liquid culture(χ2=3.55,P>0.05).Totally,188 positive liquid culture samples were confirmed by final identification,the sensitivity of Xpert MTB/RIF was 91.23%(156/171),the specificity was 88.24%(15/17),the accuracy was 90.96%(171/188),and there was no statistical significance between Xpert MTB/RIF and liquid culture(χ2=4.109,P>0.05).The sensitivity of Xpert MTB/RIF to rifampicin resistance was 82.35%(14/17),the specificity was 99.35%(1/154),and there was no statistical significance between Xpert MTB/RIF and traditional proportional method(χ2=0.138,P>0.05).Conclusions The Xpert MTB/RIF system could detect MTB and rifampicin resistance rapidly,with high sensitivity and specificity,and it is potential in the clinical application.

关 键 词：结核分枝杆菌 Xpert MTB/RIF技术 利福平 耐药 

分 类 号：R378.91[医药卫生—病原生物学]