经济欠发达地区应用GeneXpert MTB/RIF检测发现肺结核及利福平耐药的效果分析  

The effect of case finding of pulmonary tuberculosis and rifampicin resistance tuberculosis with GeneXpert MTB/RIF test in economic undeveloped areas

作　　者：阮云洲[1] 苏伟[1] 姜佳雯 李仁忠[1] RUAN Yun-zhou;SU Wei;JIANG Jia-wen;LI Ren-zhong(Department of Drug-resistant Tuberculosis Control and Prevention,National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]中国疾病预防控制中心结核病预防控制中心耐药防治部,北京102206

出　　处：《中国防痨杂志》2021年第12期1275-1279,共5页Chinese Journal of Antituberculosis

基　　金：探索提高贫困地区肺结核发现(0525)。

摘　　要：目的探索经济欠发达地区全面应用GeneXpert MTB/RIF(简称“Xpert”)检测发现肺结核及利福平耐药肺结核的效果。方法从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中,收集2017—2020年江西省赣州市肺结核登记数据,对全面应用Xpert检测的干预效果进行分析,评价干预前(2017—2018年)和干预后(2019—2020年)病原学阳性率、利福平耐药检测率、利福平耐药患者发现水平,以及耐药检测时间的变化。结果干预后,肺结核患者接受Xpert检测率从25.89%(3611/13945)提高到88.22%(9270/10508)(χ^(2)=9337.32,P=0.000),病原学阳性率从44.07%(6146/13945)提高到56.12%(5897/10508)(χ^(2)=347.90,P=0.000);病原学阳性患者耐药检测率从52.29%(3214/6146)大幅提高到93.18%(5495/5897)(χ^(2)=2511.49,P=0.000);利福平耐药肺结核发现从干预前的207例增加到305例,其中来自痰涂片阴性患者占13.11%(40/305);药物敏感性试验检测从63.0 d缩短到当天。结论Xpert检测技术的应用,可以明显提升经济欠发达地区病原学阳性和耐药肺结核的发现水平。Objective To explore the effect of applying GeneXpert MTB/RIF(Xpert for short)test to improve the case finding of pulmonary tuberculosis(PTB)and rifampicin-resistant tuberculosis in economic undeveloped areas.Methods Medical records of PTB patients in Ganzhou Prefecture Jiangxi Province between 2017 and 2020 were derived from the Tuberculosis Management Information System,a subsystem of China Disease Control and Prevention Information System.The effects of intervention measures using Xpert test before(2017-2018)and after(2019-2020)intervention were analyzed.The changes of the proportion of bacteriologically confirmed of tuberculosis,the proportion of rifampicin resistance tested of that,the number of PTB patients with rifampicin resistance,and the number of days for rifampicin resistance test before and after the application of Xpert test were compared and evaluated.Results After the intervention,the proportion of PTB patients received Xpert test increased from 25.89%(3611/13945)to 88.22%(9270/10508)(χ^(2)=9337.32,P=0.000);the proportion of bacteriologically confirmed PTB cases increased from 44.07%(6146/13945)to 56.12%(5897/10508)(χ^(2)=347.90,P=0.000);the proportion of rifampicin resistance tested of the bacteriologically confirmed cases increased significantly from 52.29%(3214/6146)to 93.18%(5495/5897)(χ^(2)=2511.49,P=0.000);rifampicin-resistant PTB increased from 207 cases to 305 cases,of which 13.11%(40/305)came from smear-negative patients;the drug susceptibility test was shortened from 63.0 days to the same day.Conclusion The application of Xpert test can significantly improve the case finding of the proportion of bacteriologically confirmed PTB cases and drug-resistant tuberculosis in economic undeveloped areas.

关 键 词：结核 肺 利福平 抗药性 细菌 核酸扩增技术 病例发现 对比研究 

分 类 号：R521[医药卫生—内科学]