结核分枝杆菌耐药基因芯片检测在复治肺结核患者中的应用价值  

Application of microarray detection of drug resistance genes of Mycobacterium tuberculosis in retreatment of patients with pulmonary tuberculosis

作　　者：施伎蝉 何贵清 宁洪叶 吴联朋 吴正兴 刘赛朵 叶新春 潘宁 蒋贤高 SHI Jichan;HE Guiqing;NING Hongye;WU Lianpeng;WU Zhengxing;LIU Saiduo;YE Xinchun;PAN Ning;JIANG Xiangao(Department of Infectious Diseases,Wenzhou Central Hospital,Wenzhou 325000,China)

机构地区：[1]温州市中心医院感染科,325000 [2]温州市中心医院检验科,325000

出　　处：《浙江医学》2020年第21期2283-2287,2304,共6页Zhejiang Medical Journal

基　　金：温州市科技计划项目(Y20170283)。

摘　　要：目的评价结核分枝耐药基因芯片检测在复治肺结核患者中的应用价值。方法应用结核分枝杆菌(MTB)耐药基因芯片检测2017年1月至2018年12月温州市中心医院161例复治肺结核感染菌株对利福平(RFP)、异烟肼(INH)、链霉素(SM)、乙胺丁醇(EMB)的耐药性,并与BACTEC MGIT 960液体培养检测结果比对,比较两种方法的符合率。结果耐药基因芯片检测与BACTEC MGIT 960药敏检测结果一致率为88.46%(92/104),灵敏度为88.52%(54/61),特异度为88.37%(38/43),阳性预测值和阴性预测值分别为91.52%(54/59)和84.44%(38/45)。与BACTEC MGIT 960药敏检测相比,MTB耐药基因芯片法检测耐RFP、INH、SM、EMB的结果一致率分别为84.62%(88/104),84.62%(88/104),86.54%(90/104),85.57%(89/104),灵敏度和特异度分别为73.68%(42/57),79.25%(42/53),77.78%(28/36),50.00%(12/24);97.87%(46/47),90.20%(46/51),91.18%(62/68),96.25%(77/80),阳性预测值和阴性预测值分别为97.67%(42/43),89.36%(42/46),82.35%(28/34),80.00%(12/15);75.41%(46/61),80.70%(46/57),88.57%(62/70),86.52%(77/89)。在59株耐药基因突变菌株中,rpoB基因突变占72.88%(43/59),katG+inhA基因突变占79.66%(47/59),rpsL基因突变占57.63%(34/59),embB基因突变占25.42%(15/59),多重耐药菌株占耐药菌株的74.57%(44/59)。结论耐药基因芯片法与BACTEC MGIT 960液体培养药敏检测具有很好的一致性,可成为筛查结核分枝杆菌耐药快速有效的方法,在复治肺结核患者中有一定的临床应用价值。Objective To evaluate the application of drug-resistant gene microarray in retreatment of patients with pulmonary tuberculosis(TB).Methods A total of 161 Mycobacterium tuberculosis(MTB)clinical isolates were collected from patients with pulmonary tuberculosis.Microarray was used to detect genes related to resistance to rifampicin(RFP),isoniazid(INH),streptomycin(SM)and ethambutanol(EMB),the results were compared with those of BACTEC MGIT 960 liquid culture test.Results The consistent rate of chip detection and drug susceptibility tests was 88.46%(92/104),the sensitivity and the specificity was 88.52%(54/61)and 88.37%(38/43),the positive predictive value and the negative predictive value was 91.52%(54/59)and 84.44%(38/45).Taking BACTEC MGIT 960 as the gold standard,the consistent rates of gene chip test were 84.62%(88/104),84.62%(88/104),86.54%(90/104)and 85.57%(89/104),the sensitivity was 73.68%,79.25%,77.78%and 50.00%,the specificity was 97.87%,90.20%,91.18%and 96.25%,and the positive predictive value was 97.67%(42/43),89.36%(42/46),82.35%(28/34)and 80.00%(12/15),the negative predictive value respectively was 75.41%(46/61),80.70%(46/57),88.57%(62/70)and 86.52%(77/89),for RFP-resistance,INH-resistance,SM-resistance,and EMB-resistance,respectively.In 59 of resistant gene mutation strain,the mutation rates of rpoB gene,katG+inhA gene,and embB rpsL gene were 72.88%(43/59),79.66%(47/59),57.63%(34/59),25.42%(15/59),respectively;and multiple drug resistant strains accounted for 74.57%(44/59).Conclusion The drug resistance gene chip has a good consistency with the BACTEC MGIT 960 liquid culture drug sensitivity test,which can be used as a rapid and effective method for screening drug resistance of Mycobacterium tuberculosis in retreatment of pulmonary tuberculosis patients.

关 键 词：肺结核 复治 耐药性 基因芯片 对比研究 

分 类 号：R521[医药卫生—内科学] R440[医药卫生—临床医学]