1596例结核分枝杆菌表型药敏检测与快速分子检测结果分析  

Analysis of phenotypic drug sensitivity test and rapid molecular detection results of 1596 cases of Mycobacterium tuberculosis

作　　者：张亚会 潘稚芬 王蔚 彭草云 吕晓东 ZHANG Yahui;PAN Zhifen;WANG Wei;PENG Caoyun;LYU Xiaodong(Graduate School of Bengbu Medical College,Bengbu 233000,China;Department of Respiratory Medicine,the First Hospital of Jiaxing,Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]浙江省嘉兴市第一医院嘉兴学院附属医院呼吸内科,浙江嘉兴314000

出　　处：《中国现代医生》2022年第5期138-143,共6页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2021ZB290);浙江省嘉兴市医学重点学科建设计划项目(2019-ZC-04);浙江省嘉兴市第一医院第二批院级课题资助项目(2020YJZD029)。

摘　　要：目的比较结核分枝杆菌表型药敏与快速分子检测结果的一致性。方法回顾性分析2017年1月至2020年12月浙江省嘉兴市第一医院确诊的1750例涂阳肺结核患者痰液、肺泡灌洗液等标本,同时进行结核菌表型药敏及快速分子检测,对两种检测结果的一致性进行比较,并对不一致的原因进行分析。结果1750例患者按流程操作共检测得到结核分枝杆菌菌株1596例(91.20%),其中1542例利福平(RFP)两种方法检测结果一致(敏感1478例,耐药64例),一致率为96.62%;54例RFP不一致(3.38%)。1520例异烟肼(INH)两种方法检测结果一致(敏感1465例,耐药55例),一致率为95.24%;76例INH不一致(4.76%)。利福平(RFP)ropB基因突变位点分子检测检出率为94.79%(91/96),表型药敏检出率为93.02%(80/86)。异烟肼(INH)katG、inhA基因突变位点分子检测检出率为95.79%(91/95),表型药敏检出率为87.91%(80/91)。分析两种检测结果不一致的原因有检测标本不一致、检测技术局限性、不同突变类型、静默突变、异质性耐药及其他耐药机制。结论结核分枝杆菌表型药敏与分子检测结果的一致性高,差异无统计学意义,临床上扩大分子药敏作为初始诊断工具,可取得早诊治、早防控的效果;当检测结果不一致时,应及时分析原因,建议有条件的结核病定点医院使用两种检测方法平行检测以提高精准度。Objective To compare the consistency of phenotypic drug sensitivity and rapid molecular detection results of Mycobacterium tuberculosis.Methods Sputum and bronchoalveolar lavage fluid(BALF)samples from 1750 patients with smear-positive pulmonary tuberculosis diagnosed in the First Hospital of Jiaxing from January 2017 to December2020 were retrospectively analyzed.Tuberculosis phenotypic drug sensitivity and rapid molecular detection were performed simultaneously.The consistency of the two detection results was compared.And the causes of inconsistency were analyzed.Results A total of 1596 cases(91.20%)of Mycobacterium tuberculosis strains were detected in 1750 patients according to the process,of which 1542 cases had consistent detection results in rifampicin(RFP)between the two methods(1478 sensitive and 64 resistant),with a concordance rate of 96.62%.Fifty-four cases RFP had inconsistent results(3.38%).The detection results of isoniazid(INH)in 1520 cases were consistent between the two methods(1465 sensitive and 55 resistant),with a concordance rate of 95.24%.Seventy-six cases INH were inconsistent(4.76%).The detection rate of the rifampicin(RFP)ropB gene mutation site was 94.79%(91/96),and the detection rate of phenotypic drug sensitivity was 93.02%(80/86).The detection rate of isoniazid(INH)katG and inhA gene mutation sites was 95.79%(91/95)and the detection rate of phenotypic drug sensitivity was 87.91%(80/91).The reasons for inconsistency between the two test results were as follows:inconsistency of test samples,limitation of detection technology,different mutation types,silent mutation,heterogeneous drug resistance,and other drug resistance mechanisms.Conclusion The consistency of phenotypic drug sensitivity and molecular detection results of Mycobacterium tuberculosis is high,and the difference is not significant.Expanding molecular drug sensitivity as an initial diagnostic tool in clinical practice can achieve the effect of early diagnosis and early treatment prevention and control.When the detection resu

关 键 词：结核分枝杆菌 体外药敏试验 表型药敏 分子检测 一致性分析 

分 类 号：R446.5[医药卫生—诊断学]