Xpert MTB/RIF技术在肺结核患者结核分枝杆菌鉴定及利福平耐药检测中的应用价值  

作　　者：赵丽丽[1] 许玲英[1] 倪慧群[1] 钟东方 

机构地区：[1]浙江省海盐县人民医院,314300 [2]浙江省海盐县疾病预防控制中心,314300

出　　处：《浙江临床医学》2023年第9期1384-1386,1396,共4页Zhejiang Clinical Medical Journal

基　　金：海盐县社会发展类项目(2020SY02)。

摘　　要：目的分析Xpert MTB/RIF技术在结核分枝杆菌鉴定及利福平耐药性的检验效能及临床应用价值。方法收集感染科初诊疑似肺结核患者痰液样本,以临床确诊为金标准,评估涂片荧光染色法、Xpert MTB/RIF、液体培养法对结核分枝杆菌检测效能。以比例法药敏试验为金标准,评估Xpert MTB/RIF技术对结核分枝杆菌利福平耐药性检验效能。结果2019年5月至2021年5月初诊疑似肺结核患者593例,确诊肺结核141例,非结核分枝杆菌感染14例,其他肺部感染438例。593例疑似肺结核患者中,三种方法检测阳性率分别为:荧光染色法16.7%,Xpert MTB/RIF法23.4%,液体培养法23.6%。141例确诊肺结核患者中男性占比75.2%,其中涂片法敏感性为58.9%低于Xpert MTB/RIF 98.6%和液体培养法99.3%,涂片法特异性为96.46%、Xpert MTB/RIF和液体培养法特异性均为100%。Xpert MTB/RIF和液体培养法检测MTB一致性Kappa值均>0.99。以140株培养阳性结核杆菌比例法药敏试验结果为金标准,Xpert MTB/RIF法检测利福平耐药敏感性87.5%、特异性100%、准确性99.3%,与比例法药物敏感性试验结果一致性Kappa值0.93,结核杆菌利福平耐药率女性(8.6%)高于男性(4.8%)。结论临床确诊肺结核患者中Xpert MTB/RIF检测结核分枝杆菌一致性高、操作简单、敏感性与特异性好,对利福平耐药性检测与比例法比较结果符合率高。Xpert MTB/RIF可作为快速检测MTB及利福平耐药性的有效方法,并可为临床快速选择治疗方案提供参考。Objective To analyze the efficacy and clinical application value of Xpert MTB/RIF technology in the detection of Mycobacterium tuberculosis(MTB)and rifampicin resistance.Methods Sputum samples were collected from suspected pulmonary tuberculosis patients and the gold standard clinical diagnosis was performed to evaluate the efficacy of smear fluorescent staining,Xpert MTB/RIF,and liquid culture methods in the detection of Mycobacterium tuberculosis.Results From May 2019 to May 2021,593 patients with suspected pulmonary tuberculosis were initially diagnosed.Of these,141 patients were diagnosed with confirmed pulmonary tuberculosis,14 patients with non-tuberculous mycobacterium infection and 438 patients with other pulmonary infections.Among 593 suspected pulmonary tuberculosis patients,the positivity rates of detection varied among the three methods,Fluorescence staining method(16.7%),Xpert MTB/RIF method(23.4%),and liquid culture method(23.6%).Males accounted for 75.2%of the 141 patients with confirmed pulmonary tuberculosis.The sensitivity of the smear method was 58.9%,lower than that of Xpert MTB/RIF(98.6%)and liquid culture method(99.3%).The specificity of the smear method was 96.46%,and the specificity of Xpert MTB/RIF and liquid culture Methods were both 100%.The Kappa value of consistency of MTB detected by Xpert MTB/RIF and liquid culture Methods were greater than 0.99.Based on the results of the drug sensitivity test of 140 culture-positive Mycobacterium tuberculosis strains by the gold standard proportion method,the sensitivity,specificity and accuracy of the Xpert MTB/RIF method for the detection of rifampicin resistance were 87.5%,100%and 99.3%,and the Kappa value was 0.93.The rifampicin resistance rate of Mycobacterium tuberculosis was 8.6%higher in women than in men 4.8%.Conclusion Among the patients with clinically confirmed pulmonary tuberculosis,using the Xpert MTB/RIF method to detect Mycobacterium tuberculosis is highly consistent,simple to operate,and high in sensitivity and specificity.Results

关 键 词：Xpert MTB/RIF 结核分枝杆菌 比例法药敏 耐药性 

分 类 号：R521[医药卫生—内科学]