荧光PCR探针熔解曲线技术在评估痰液结核分枝杆菌利福平耐药性的临床价值  

Clinical Value of Fluorescence PCR Probe Melting Curve Technique in Assessing Rifampicin Resistance of Mycobacterium Tuberculosis in Sputum

作　　者：郑丽丽 刘美岑 ZHENG Li-li;LIU Mei-cen(Medical Nursing College,Minxi Vocational and Technical College,Fujian Longyan,364000;Department of Pharmacy,the first hospital of Longyan,Fujian Longyan,364000)

机构地区：[1]闽西职业技术学院医学护理学院,福建龙岩364000 [2]福建省龙岩市第一医院药剂科,福建龙岩364000

出　　处：《农垦医学》2024年第6期507-510,542,共5页Journal of Nongken Medicine

基　　金：福建省教育厅中青年科技类科研项目(JAT231279)。

摘　　要：目的:探究荧光PCR探针熔解曲线(MeltPro)技术在评估痰液结核分枝杆菌(Mycobacteriumtuberculosis,MTB)对利福平(Rifampicin,RFP)耐药性中的临床应用价值。方法:回顾性分析本院2020年10月-2023年10月收治的60例结核病患者的临床资料,对采样痰标本行涂片镜检+MTB分离培养,对培养阳性标本行RFP比例法药敏试验,同时直接应用GeneXpert MTB/RIF和MeltPro技术对采样痰标本行RFP耐药性检测。比较3种方法检测RFP耐药性的差异,并以比例法药敏试验结果为金标准判断MeltPro技术的诊断效能。结果:60例结核病患者临床共分离MTB 47株,非MTB 1株,总体分离率78.33%。47株MTB比例法药敏试验、MeltPro技术检出32株对RFP耐药,耐药率为68.09%;GeneXpert MTB/RIF技术检出31株对RFP耐药,耐药率为68.96%,3种药敏试验方法检测RFP耐药性差异无统计学意义(P>0.05)。以比例法药敏试验为金标准,GeneXpert MTB/RIF、MeltPro技术检测RFP耐药性的灵敏度、特异度、准确率、阳性预测值、阴性预测值、一致性分别为93.75%、93.33%、93.62%、96.77%、87.50%、0.856和96.88%、93.33%、95.74%、96.88%、93.33%、0.902。结论:MeltPro技术检测结核病患者检测MTB对RFP耐药性的灵敏度、特异度、准确率均较高,可用于快速准确筛查RFP耐药结核病,指导临床合理用药与治疗。Objective:To explore the clinical value of fluorescence PCR probe melting curve(MeltPro)in the evaluation of sputum Mycobacterium tuberculosis(MTB)resistance to Rifampicin(RFP).Methods:The clinical data of 60 patients with tuberculosis admitted to our hospital from October 2020 to October 2023 retrospectively,RFP susceptibility test was performed on the culture positive samples,and the resistance of sputum samples to RFP was detected by GeneXpert MTB/RIF and MeltPro.The difference of resistance of RFP detected by three methods was compared,and the diagnostic efficacy of MeltPro was judged by the results of proportional susceptibility test as the gold standard.Results:A total of 47 strains of MTB and 1 strain of non-MTB were isolated from 60 patients with tuberculosis.The total isolation rate was 78.33%.32(68.09%)of 47 strains of MTB were resistant to RFP,and 31(68.96%)were resistant to RFP by genexpert MTB/Rif.There was no significant difference among the three methods(P>0.05),the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and concordance of GeneXpert MTB/Rif and MeltPro were 93.75%,93.33%,93.62%,96.77%,87.50%,0.856 and 96.88%,93.33%,95.74%,96.88%,93.33%,0.902 respectively.Conclusion:The sensitivity,specificity and accuracy of the detection of MTB in the detection of RFP-resistant tuberculosis patients by MeltPro technique are high.It can be used for rapid and accurate screening of RFP-resistant Tuberculosis and guiding clinical rational drug use and treatment.

关 键 词：荧光PCR探针熔解曲线技术 GeneXpert MTB/RIF技术 比例法药敏试验 痰标本 结核分枝杆菌 利福平 耐药性 

分 类 号：R521[医药卫生—内科学]