分子生物学方法在提高综合医院传染性肺结核发现率中的作用  

Application of molecular biology to enhance the detection of infectious tuberculosis in general hospitals

作　　者：马樱子[1] 代晓琦 李仁忠[3] 池水晶 高建国[5] 刘新儒 闫晓伟 徐岩 MA Yingzi;DAI Xiaoqi;XU Yan(Department of Tuberculosis Prevention and Control,Chengde Center for Disease Control and Prevention,Hebei,Chengde 067000,China;不详)

机构地区：[1]河北省承德市疾病预防控制中心(承德市卫生监督所)结核病防治科,067000 [2]山东省青岛市疾病预防控制中心 [3]中国疾病预防控制中心结核病预防控制中心耐药防治部 [4]承德医学院附属医院院感科 [5]河北省承德市中心医院急诊科 [6]河北省承德市疾病预防控制中心(承德市卫生监督所)疾病控制科,067000 [7]河北省平泉市中医院

出　　处：《河北医药》2024年第12期1890-1893,共4页Hebei Medical Journal

基　　金：承德市科技计划项目(编号:202303A003)。

摘　　要：目的 了解综合医院使用Xpert技术诊断传染性肺结核和耐药肺结核的现状和问题,以便更好地发挥综合医院在肺结核发现中的前哨作用。方法 采用自身前后对照的研究方法,对比分析综合医院使用Xpert检查和未使用Xpert检查患者2组之间的病原学阳性患者比例、利福平耐药肺结核患者发现、肺结核和利福平耐药肺结核患者诊断时间等指标。共有171例肺结核患者纳入本次研究,其中研究组为使用Xpert检查的52例患者,对照组为未使用Xpert检查的119例患者。采用Wilcoxon秩和检验和χ^(2)检验(Fisher精确检验)分析组间差异。结果 研究组中综合医院诊断的病原阳性肺结核比例(41/52,78.85%)明显高于对照组(65/119,54.62%),差异有统计学意义(P<0.05)。研究组中综合医院诊断的疑似病例比例(2/52,3.85%)明显低于对照组(24/119,20.17%)。研究组中肺结核诊断时间为1 d,明显短于对照组(4 d)差异有统计学意义(P<0.05)。研究组共有3例利福平耐药肺结核患者,在综合医院就诊时全部得到明确诊断,利福平耐药诊断时间为1 d;对照组中有1例利福平耐药患者,综合医院未能发现。研究组同时接受痰涂片和Xpert检查的52例患者中,Xpert检出结核分枝杆菌比例(40/52,76.92%)明显高于痰涂片检查(25/52,48.07%),差异有统计学意义(P<0.05)。结论 Xpert技术能够显著提高肺结核病的诊断率、早期发现传染性肺结核和利福平耐药肺结核患者,建议将其纳入医保报销范围,加快在综合医院推广应用。Objective To understand the current status and issues of using Xpert for diagnosing infectious and drug-resistant tuberculosis(TB)in general hospitals,thus better exerting the frontrunner role of general hospitals in detecting TB.Methods This was a self-controlled before-and-after study comparing the proportion of pathogenetically positive patients,patients with Rifampicin-Resistant TB,and diagnosis time of patients with TB and Rifampicin-Resistant TB in general hospitals either using the Xpert or not.A total of 171 TB patients were enrolled,including 52 in the research group receiving Xpert,and 119 in the control group without examination of Xpert.Differences between groups were compared by the Wilcoxon signed rank test and Chi-square test(Fisher’s exact test).Results In the research group,the proportion of positive TB diagnosed in general hospitals was significantly higher than that of the control group(78.85%[41/52]vs 54.62%[65/119],P<0.05).The proportion of suspected cases diagnosed in general hospitals was significantly lower in the research group than that of the control group(3.85%[2/52]vs 20.17%[24/119],P<0.05).The diagnosis time for TB in the research group was significantly shorter than that of the control group(1 day vs 4 days,P<0.05).In the research group,there were 3 cases of Rifampicin-Resistant TB diagnosed within 1 day when they sought medical care in a general hospital.There was one Rifampicin-Resistant TB patient in the control group that failed to be diagnosed in the general hospital.Of 52 patients in the research group who were examined by both sputum smear and Xpert examination,the proportion of Mycobacterium Tuberculosis(MTB)detected by Xpert was significantly higher than that by sputum smear(76.92%[40/52]vs 48.07%[25/52],P<0.05).Conclusion The use of Xpert technology can improve the diagnosis rate of TB,achieving an early detection of infectious TB and Rifampicin-Resistant TB.Epert is recommended to be included in the reimbursement of medical insurance,and acceleration of its application

关 键 词：结核 肺 抗药性 诊断技术 自身对照研究 

分 类 号：R521[医药卫生—内科学]