耐药基因芯片技术对耐药结核患者早期诊治价值的研究  

Application of drug-resistant gene chip technique in early diagnosis and treatment of drug-resistant tuberculosis patients

作　　者：童涌[1] 宋群[1] 童照威[1] TONG Yong;SONG Qun;TONG Zhaowei(Department of Infectious Disease,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院感染科,313000

出　　处：《浙江医学》2022年第4期384-387,391,共5页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF19H010003);湖州市公益性应用研究项目(2017GYB30)。

摘　　要：目的探讨耐药基因芯片技术对耐药结核患者早期诊治的价值。方法选取2018年6月至2020年12月湖州市中心医院感染科结核病门诊辖区内(吴兴区、南浔区)登记的细菌学阳性患者882例为研究对象,其中耐药基因芯片技术引入前(采用传统药敏试验)308例,为对照组;耐药基因芯片技术引入后(同时采用传统药敏试验和耐药基因芯片技术检测)574例,为观察组。两组患者均给予规范化抗结核治疗,并根据传统药敏试验或耐药基因芯片技术检测结果及时调整治疗方案。评估两组患者异烟肼及利福平耐药检出率、耐药性反馈时间以及治疗第2或6个月末临床症状、影像学好转及痰检阴转情况。结果观察组(基因法)、观察组(传统法)、对照组(传统法)患者异烟肼或利福平耐药分别108、113、52例。观察组(基因法)、观察组(传统法)、对照组(传统法)耐药性反馈时间比较,差异有统计学意义(P<0.05),其中观察组(基因法)耐药性反馈时间短于对照组(传统法)、观察组(传统法)(均P<0.05),而观察组(传统法)与对照组(传统法)耐药性反馈时间比较差异无统计学意义(P>0.05)。治疗第2个月末,观察组(基因法)患者总体临床症状好转率、影像学好转率、痰检转阴率均明显高于对照组(传统法)(均P<0.05);治疗第6个月末,两组患者总体临床症状好转率、影像学好转率、痰检转阴率比较,差异均无统计学意义(均P>0.05)。结论耐药基因芯片技术能提高耐药结核的早期快速诊断,有利于治疗方案调整时机前移,提高患者治疗效果。Objective To assess the application of drug-resistant gene chip technique in the early diagnosis and treatment of drug-resistant tuberculosis patients.Methods From June 2018 to December 2020,882 bacteriologically positive patients registered in tuberculosis outpatient clinic of infection department of Huzhou Central Hospital were enrolled in the study,including 308 cases using conventional drug sensitivity test(control group)and 574 cases using both conventional drug sensitivity test and drug resistance gene chip(study group).Patients in both groups received standardized anti-tuberculosis treatment,and the treatment regimen was adjusted timely according to the results of resistance tests.The detection rates of drug resistance to isoniazid and rifampicin,feedback time of drug resistance,clinical symptoms,imaging improvement and sputum negative conversion at the end of the 2nd or 6th month of treatment were evaluated.Results The drug resistance to isoniazid or rifampicin was detected in 52 cases of control group,while in study group the resistance was detected in 108 cases by conventional method and 113 cases by gene chip technique,respectively.The feedback time of drug resistance in the study group with gene chip method was shorter than that in the control group and in study group with conventional method (all P<0.05),while there was no significant difference in the feedback time of drug resistance between the study group with conventional method and the control group(P>0.05).At the end of the 2nd month,the overall clinical symptom improvement rate,imaging improvement rate and sputum negative conversion rate of patients in the study group were significantly higher than those in the control group(all P<0.05).At the end of the 6th month of treatment,there were no significant differences in the overall clinical symptom improvement rate,imaging improvement rate and sputum negative conversion rate between two groups(all P>0.05).Conclusion Drugresistant gene chip technique can improve the early diagnosis of drug-resista

关 键 词：结核 耐药基因芯片技术 临床诊断 异烟肼 利福平 耐药 

分 类 号：R52[医药卫生—内科学]