Xpert-结核分枝杆菌及利福平耐药检测弱阳性结果对耐多药肺结核的诊断价值及其产生原因分析  

Weakly Positive Results of Xpert-MTB/RIF Assay for Diagnosis of Multi-drug Resistant Tuberculosis and Analysis of Its Causes

作　　者：宋翌琰 唐娜[3] 徐俊驰[1,2] 郦芳华 翟云霞 宋华峰[1,2,4] 唐佩军 朱晓燕[1,2] 吴越人[1,2] SONG Yi-yan;TANG Na;XU Jun-chi;LI Fang-hua;ZHAI Yun-xia;SONG Hua-feng;TANG Pei-jun;ZHU Xiao-yan;WU Yue-ren(The Fifth People’s Hospital of Suzhou,Suzhou Jiangsu 215131,China;The Affiliated Infectious Diseases Hospital of Soochow University,Suzhou Jiangsu 215131,China;School of Medical Laboratory Technology of Soochow University,Suzhou Jiangsu 215301,China;Key Laboratory of Tuberculosis Control in Suzhou,Suzhou Jiangsu 215000,China)

机构地区：[1]苏州市第五人民医院,江苏苏州215131 [2]苏州大学附属传染病医院,江苏苏州215131 [3]苏州大学医学检验技术学系,江苏苏州215301 [4]苏州市结核病防治重点实验室,江苏苏州215000

出　　处：《抗感染药学》2020年第11期1569-1573,共5页Anti-infection Pharmacy

基　　金：国家自然科学基金青年项目(编号:81900577);苏州市民生科技——医疗卫生应用基础研究(编号:SYS2020191)。

摘　　要：目的:分析Xpert-结核分枝杆菌及利福平耐药检测(Xpert-MTB/RIF)弱阳性结果对耐多药肺结核(MDRTB)的诊断价值,探究肺结核患者Xpert-MTB/RIF产生弱阳性结果的可能原因。方法:选取医院2019年经XpertMTB/RIF检测患者资料,分析其患者Xpert-MTB/RIF弱阳性的抗酸染色涂片镜检、结核培养、肺部CT和临床诊断结果,比较阳性和阴性患者对耐药肺结核的诊断意义。结果:Xpert-MTB/RIF弱阳性患者的临床诊断为肺结核的发生率显著高于阴性患者(48.36%vs 29.17%),但其低于阳性患者(48.36%vs 83.78%);其检测弱阳性的肺结核患者结核分枝杆菌培养阳性率低于阳性患者(43.14%vs 79.31%),但其高于阴性患者(43.14%vs 16.67%);抗酸染色结果发现,Xpert-MTB/RIF检测弱阳性肺结核患者的阳性率低于阳性肺结核患者(27.45%vs 75.86%),但其高于阴性患者(27.45%vs 8.33%);联合CT检查结果发现,Xpert-MTB/RIF阳性和弱阳性的肺结核患者肺部存在空洞发生率高于阴性患者,而肺部病灶数的发生率也高于阴性组。结论:Xpert-MTB/RIF检测产生弱阳性结果可能与结核分枝杆菌数量和病情的严重程度相关,所以Xpert-MTB/RIF检测的弱阳性对耐药肺结核的诊断有一定的指导作用。Objective:To analyze the diagnostic value of weakly positive results of Xpert-MTB/RIF in the diagnosis of multi-drug resistant tuberculosis(MDR-TB)in clinic,and to explore the possible reasons for weak positive XpertMTB/RIF results in tuberculosis patients.Methods:The data of patients tested by Xpert-MTB/RIF in hospitals in 2019 were selected to analyze their weakly positive Xpert-MTB/RIF anti-acid smear microscopy,tuberculosis culture,lungs CT and clinical diagnosis results,and to compare the diagnostic significance of positive and negative patients for drugresistant tuberculosis.Results:The rate of tuberculosis diagnosis in Xpert-MTB/RIF weakly positive was significantly higher than that of negative patients(48.36%vs 29.17%),but lower than that in positive patients(48.36%vs 83.78%).The weakly positive rate of TB culture in Xpert-MTB/RIF positive patients was significantly lower than that in positive(43.14%vs 79.31%),but higher than that in negative patients(43.14%vs 16.67%).The weak positive rate of acid-fast stain test in Xpert MTB/RIF positive patients was significantly lower than that in positive(27.45%vs 75.86%),but higher than that of negative patients(27.45%vs 8.33%).The rate of existing pulmonary cavity from CT results in XpertMTB/RIF positive and weakly positive pulmonary tuberculosis patients was higher than that in negative patients,while the number of pulmonary lesions in Xpert-MTB/RIF positive and weakly positive pulmonary tuberculosis patients was also higher than that in negative patients.Conclusion:The weakly positive results of Xpert-MTB/RIF tests may be related to the number of mycobacterium tuberculosis and the severity of the disease.Thus,the weakly positive results of Xpert-MTB/RIF tests may be valuable for the diagnosis of drug-resistant tuberculosis.

关 键 词：Xpert-MTB/RIF 弱阳性 抗酸染色涂片 耐药肺结核 利福平耐药 

分 类 号：R915[医药卫生—微生物与生化药学] R446.5[医药卫生—药学]