Xpert MTB/RIF对结核菌利福平耐药的诊断价值及rpoB基因突变特点的分析  

Diagnostic value of Xpert MTB/RIF assay in rifampicin resistance of Mycobacterium tuberculosis and analysis of rpoB gene mutation characteristics

作　　者：高春景[1] 杨洋 阚宗卫 成松[1] 魏素梅[1] 胡凯[1] GAO Chun-jing;YANG Yang;KAN Zong-wei;CHENG Song;WEI Su-mei;HU Kai(Department of Tuberculosis,Xuzhou Infectious Disease Hospital,Xuzhou,Jiangsu 221004,China)

机构地区：[1]徐州市传染病医院结核科,江苏徐州221004

出　　处：《临床肺科杂志》2021年第5期723-727,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析Xpert MTB/RIF检测对结核分枝杆菌利福平耐药的诊断价值及rpoB基因突变特点。方法回顾分析2016年1月至2020年6月期间来院就诊患者相同标本,同时进行了结核分枝杆菌培养及药敏试验和Xpert MTB/RIF检测,且任一种方法检出MTB。结果用Xpert MTB/RIF及培养药敏两种方法检测标本共7659例,Xpert MTB/RIF对MTB的检出率高,且有统计学意义(P<0.05)。两种方法同时检出MTB 3621例,Xpert MTB/RIF检出利福平耐药262例,培养药敏检出利福平耐药238例;两种方法检测利福平耐药的一致率为99.01%;采用Kappa检验,两种方法的检测结果完全符合。RR-TB探针突变的频率为E探针63.37%、D探针20.16%、B探针8.23%、A探针4.53%、C探针0.82%、联合探针突变2.88%;以培养药敏结果为利福平耐药的金标准,Xpert无探针突变组利福平耐药的准确性要明显低于有探针突变组;初治和复治病例探针突变频率差异有统计学意义。结论Xpert MTB/RIF检测可以快速有效的诊断利福平耐药结核,有助于早发现、早治疗。利福平耐药结核探针突变主要发生在E探针和D探针,C探针突变最少。Objective To analyze the diagnostic value of Xpert MTB/RIF assay for rifampicin resistance of Mycobacterium tuberculosis and the characteristics of rpoB gene mutation.Methods Retrospective analysis was performed on the same samples of patients admitted to the hospital from January 2016 to June 2020 who were simultaneously tested for mycobacterium tuberculosis culture and drug sensitivity test and Xpert MTB/RIF assay.At the same time,MTB was positive by either of the two methods.Results A total of 7659 samples were detected by Xpert MTB/RIF and mycobacterium tuberculosis culture.Xpert MTB/RIF assay had a high detection rate of MTB,and the detection rate was statistically significant(P<0.05).A total of 3621 cases of MTB were detected by the two methods,262 cases were rifampicin resistant by Xpert MTB/RIF assay,and 238 rifampicin resistant cases were detected by culture drug sensitivity.The coincidence rate of rifampicin resistance detected by two methods was 99.01%.Kappa test was used,and the test results of the two methods were completely consistent.The mutation frequency of probe of RR-TB were:probe E 63.37%,probe D 20.16%,probe B 8.23%,probe A 4.53%,probe C 0.82%,and combination probe 2.88%.Taking culture drug sensitivity as the gold standard of rifampicin resistance,rifampicin resistance accuracy of the Xpert probe free mutation group was significantly lower than that of the probe mutation group.There was statistically significant difference in the frequency of probe mutation between primary and secondary treatment cases.Conclusion Xpert MTB/RIF assay is a rapid and effective method for the diagnosis of rifampicin resistant tuberculosis,which is helpful for early detection and treatment.The mutations of rifampicin resistant TB probes are mainly found at probe E and probe D,while the mutation of probe C is the least.

关 键 词：结核分枝杆菌 Xpert MTB/RIF 耐药 rpob突变 

分 类 号：R446.5[医药卫生—诊断学] R52[医药卫生—临床医学]