最低抑菌浓度法在耐药结核分枝杆菌药敏试验中的应用  

Application of minimum inhibitory concentration method in drug sensitivity test of drug-resistant Mycobacterium tuberculosis

作　　者：吴敏[1,2] 周洪经 李志媛[1,2] 张秀雯 孙海柏[1,2] 张丽霞 陈怀永 WU Min;ZHOU Hongjing;LI Zhiyuan;ZHANG Xiuwen;SUN Haibai;ZHANG Lixia;CHEN Huaiyong(Tianjin Haihe Hospital,Tianjin 300350,China;不详)

机构地区：[1]天津市海河医院,天津300350 [2]国家中医药管理局中医药防治传染病重点研究室

出　　处：《山东医药》2021年第12期42-46,共5页Shandong Medical Journal

基　　金：天津市海河医院科技基金(HHYY-201903)。

摘　　要：目的分析最低抑菌浓度法(MIC法)在耐药结核分枝杆菌药敏试验中的应用价值。方法对129例临床培养阳性的结核分枝杆菌进行抗结核药物敏感性检测,以改良罗氏比例法药敏试验结果为金标准,分析微量MIC法的灵敏度、特异度、阴性预测值、阳性预测值及诊断符合率。结果以改良罗氏比例法药敏试验为金标准,MIC法药敏试验对于链霉素(SM)药敏检测的灵敏度为100.0%,特异度为97.1%,阳性预测值为89.6%,阴性预测值为100.0%,诊断符合率为97.7%;对异烟肼(INH)药敏检测的灵敏度为96.3%,特异度为98.0%,阳性预测值为92.8%,阴性预测值为99.0%,诊断符合率为97.7%;对利福平(RFP)药敏检测的灵敏度为95.0%,特异度为99.1%,阳性预测值为95.0%,阴性预测值为99.1%,诊断符合率为98.4%;对乙胺丁醇(EMB)药敏检测的灵敏度为83.3%,特异度为99.1%,阳性预测值为90.9%,阴性预测值为98.3%,诊断符合率为97.7%;对卡那霉素(KAN)药敏检测的灵敏度为38.5%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为93.5%,诊断符合率为93.8%;对氨基水杨酸(PAS)药敏检测的灵敏度为50.0%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为96.8%,诊断符合率为96.9%;对卷曲霉素(CPM)药敏检测的灵敏度为66.6%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为98.4%,诊断符合率为98.4%。结论与改良罗氏比例法药敏试验比较,MIC法药敏试验对于4种一线抗结核药物链霉素、异烟肼、利福平、乙胺丁醇和3种二线抗结核药物卡那霉素、对氨基水杨酸、卷曲霉素的药物敏感性检测符合率较高,同时也是一种快速、操作方便、定量和准确的方法,结合药物的MIC值可以为临床个体化用药精准治疗提供依据,同时也有利于新药的研究和开发,更好的满足临床需求。Objective To analyze the application of minimum inhibitory concentration(MIC)method in drug sensitivity test of drug-resistant Mycobacterium tuberculosis(MTB).Methods The sensitivity of 129 positive Mycobacterium tuberculosis to anti tuberculosis drugs after clinical culture was detected.Modified Roche ratio drug sensitivity test was used as the gold standard to analyze the sensitivity,specificity,negative predictive value,positive predictive value and diagnostic coincidence rate.Results By using the results of modified Roche ratio drug sensitivity test as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of streptomycin(SM)in MIC drug susceptibility test were 100%,97.1%,89.6%,100%and 97.7%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of isoniazid(INH)in drug susceptibility test were 96.3%,98.0%,92.8%,99.0%and 97.7%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of rifampicin(RFP)in drug susceptibility test were 95.0%,99.1%,95.0%,99.1%and 98.4%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of ethambutol(EMB)in drug susceptibility test were 83.3%,99.1%,90.9%,98.3%and 97.7%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of kanamycin(KAN)in drug susceptibility test were 38.5%,100.0%,100.0%,93.5%and 93.8%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of para-aminosalicylic acid(PAS)in drug susceptibility test were 50.0%,100.0%,100.0%,96.8%and 96.9%.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of capreomycin(CPM)in drug susceptibility test were66.6%,100.0%,100.0%,98.4%,and 98.4%.Conclusions Compared with the modified Roche ratio drug sensitivity test,

关 键 词：结核分枝杆菌 最低抑菌浓度法药敏试验 改良罗氏比例法药敏试验 

分 类 号：R825.2[医药卫生—临床医学]