GeneXpert MTB/RIF检出量与结核分枝杆菌培养和利福平表型耐药的关系  

Relationship between GeneXpert MTB/RIF assay determination load and Mycobacterium tuberculosis culture and phenotype of rifampicin resistance

作　　者：缪星国 叶慧 苏菲菲 MIAO Xingguo;YE Hui;SU Feifei(Department of Infectious Diseases,Wenzhou Central Hospital,Wenzhou 325099,Zhejiang,China;Wenzhou Central Hosital,Wenzhou Key Laboratory for Diagnosis and Treatment of Emerging Infectious Diseases,Wenzhou 325099,Zhejiang,China)

机构地区：[1]温州市中心医院感染科,浙江温州325099 [2]温州市中心医院温州市新发与再发传染病诊治重点实验室,浙江温州325099

出　　处：《检验医学》2023年第9期874-877,共4页Laboratory Medicine

摘　　要：目的探讨痰液GeneXpert MTB/RIF(Xpert)检出量与结核分枝杆菌(MTB)培养阳性率和利福平耐药表型的关系。方法选取2016年4月—2019年12月温州市中心医院痰液Xpert检测为利福平耐药的初治肺结核患者183例。比较不同Xpert检出量患者MTB培养阳性率和利福平耐药表型假阳性率的差异。结果183例患者中,痰液Xpert检出量为高、中、低、极低的患者分别有48、46、56、33例。有80.87%(148/183)的患者MTB培养阳性。148例MTB培养阳性患者对一线抗结核药物异烟肼、利福平、乙胺丁醇、链霉素的耐药率分别为79.05%(117/148)、81.08%(120/148)、27.03%(40/148)、52.70%(78/148);对4种药物全敏感的患者11例,全耐药26例;单种药物耐药24例,以单耐利福平最常见(17例);耐2种药物34例,以耐利福平和异烟肼最常见(25例);耐3种药物53例,以耐利福平、异烟肼、链霉素最常见(40例)。Xpert检出量为极低、低、中、高的患者MTB培养阳性率分别为48.48%、76.79%、93.48%、95.83%,不同Xpert检出量患者MTB培养阳性率差异有统计学意义(P<0.001)。Xpert检出量为极低、低、中、高的患者利福平耐药表型假阳性率分别为43.75%、23.26%、13.95%、10.87%,不同Xpert检出量患者利福平耐药表型假阳性率差异具有统计学意义(P=0.022)。结论痰液Xpert检测可减少肺结核患者的漏诊,但检出量较低时,易出现MTB培养假阴性、利福平耐药假阳性。Objective To analyze the relationship between GeneXpert MTB/RIF assay(Xpert)determination load and Mycobacterium tuberculosis(MTB)culture positive rate and rifampicin resistance phenotype.Methods From April 2016 to December 2019,the patients whose sputum Xpert determination results showed rifampicin resistance were enrolled from Wenzhou Central Hospital,and the differences between the positive rate of MTB and fasle positive rate for determining rifampicin resistance among patients with different Xpert determination loads were evaluated.Results Of the 183 patients,48,46,56 and 33 cases showed Xpert determination loads of high,medium,low and very low,respectively.Positive MTB culture was found in 80.87%(148/183)patients.The drug resistance rates of first-line anti-tuberculosis drugs were 79.05%(117/148)for isoniazid,81.08%(120/148)for rifampicin,27.03%(40/148)for ethambutol and 52.70%(78/148)for streptomycin.Totally,11 cases were fully sensitive to first-line anti-tuberculosis drugs.Among the 24 patients who were only resistant to 1 drug,the most common one was rifampicin(17 cases).Totally,34 patients were resistant to 2 drugs,and rifampicin and isoniazid were the most common(25 cases);53 patients were resistant to 3 drugs,among which rifampicin,isoniazid and streptomycin were the most common(40 cases).The positive rates of MTB culture in patients with very low,low,medium and high Xpert determination loads were 48.48%,76.79%,93.48%and 95.83%,respectively.There was statistical significance in MTB culture's positive rates among patients with different Xpert determination loads(P<0.001).The false positive rates of rifampicin phenotypes were 43.75%,23.26%,13.95%and 10.87%in patients with very low,low,medium and high Xpert determination loads,respectively.There was statistical significance in the false-positive rates of rifampicin phenotypes among patients with different Xpert determination loads(P=0.022).Conclusions The determination of MTB with Xpert could reduce the missed diagnosis rate of culture-negative pulmonary

关 键 词：GeneXpertMTB/RIF检测 结核分枝杆菌 利福平耐药 表型 Xpert检出量 

分 类 号：R378.91[医药卫生—病原生物学]