摘要
目的探讨GeneXpert MTB/RIF(简称“GeneXpert”)和线性探针技术检测骨关节结核及利福平耐药性的临床应用价值。方法选取2018年3-12月接受病灶清除手术或穿刺术的疑似骨关节结核患者172例,同时采用GeneXpert、线性探针技术及BACTEC MGIT 960对患者病灶标本进行检测。以临床综合诊断为参照标准,评价GeneXpert、线性探针技术及两种方法联合检测骨关节结核的效能。以BACTEC MGIT 960药物敏感性试验(DST)结果为参照标准,评价GeneXpert、线性探针技术及两种方法联合检测MTB对利福平耐药性的效能。结果 172例疑似骨关节结核患者经临床综合诊断,112例诊断为骨关节结核,60例为非骨关节结核。以临床综合诊断为参照标准,GeneXpert检测骨关节结核的敏感度和特异度分别为82.14%(92/112)和96.67%(58/60),与临床诊断结果一致性良好(Kappa=0.74);线性探针技术检测的敏感度和特异度分别为69.64%(78/112)和90.00%(54/60),与临床诊断结果一致性一般(Kappa=0.54);两种方法联合检验的敏感度和特异度分别为82.14%(92/112)和90.00%(54/60),与临床诊断结果一致性良好(Kappa=0.68)。三种方法诊断骨关节结核的受试者工作特征曲线(简称“ROC曲线”)下面积分别为0.89、0.80、0.86,提示诊断价值均较好。以BACTEC MGIT 960 DST 结果为参照标准,GeneXpert检测MTB对利福平耐药性的敏感度和特异度分别为100.00%(18/18)和92.31%(24/26),与BACTEC MGIT 960 DST结果一致性较高(Kappa=0.91),ROC曲线下面积为0.96;线性探针技术检测MTB对利福平耐药性的敏感度和特异度分别为100.00%(18/18)和88.46%(23/26),与BACTEC MGIT 960 DST结果一致性较高(Kappa=0.86),ROC曲线下面积为0.94;两种方法联合检验结果与线性探针技术检测结果一致。结论 GeneXpert、线性探针技术能够快速、准确的检测骨关节结核及其耐药性,具有较好的临床应用价值。
Objective To investigate the value of GeneXpert MTB/RIF (GeneXpert) and line probe assay for rapid diagnosis of osteoarticular tuberculosis and detection of rifampicin resistance. Methods A total of 172 suspected osteoarticular tuberculosis patients who received focal cleaning or paracentesis between March to December 2018 were selected. GeneXpert, line probe assay and BACTEC MGIT 960 mycobacterial culture were used to test the samples. Using clinical comprehensive diagnosis as the reference standard, the efficacy of GeneXpert, linear probe assay and combination of the two methods in diagnosis of osteoarticular tuberculosis were evaluated. Using mycobacterial culture drug sensitivity test as the reference standard, the efficacy of GeneXpert, linear probe assay and combination of the two methods in detecting rifampicin resistance were evaluated. Results According to the clinical comprehensive diagnosis of the 172 suspected osteoarticular tuberculosis patients, 112 were diagnosed with osteoarticular tuberculosis, whereas 60 were non-tuberculosis. Using clinical comprehensive diagnosis as the reference standard, the sensitivity and specificity of GeneXpert were 82.14%(92/112) and 96.67%(58/60). The results of GeneXpert was consistent with that of clinical comprehensive diagnosis (Kappa=0.74). The sensitivity and specificity of line probe assay were 69.64%(78/112) and 90.00%(54/60). The consistency with clinical comprehensive diagnosis was not good (Kappa=0.54). The sensitivity and specificity of combination of the two methods were 82.14%(92/112) and 90.00%(54/60). The combination method had good consistency with clinical comprehensive diagnosis (Kappa=0.68).The area under the receiver operating characteristic (ROC) curve of GeneXpert, line probe assay and combination of the two methods were 0.89, 0.80 and 0.86, respectively, indicating good diagnosis performance. Using mycobacterial culture drug sensitivity test as the reference standard, the sensitivity and specificity of GeneXpert in inspection to rifampicin resis
作者
盛杰
古甫丁
古丽比克·木拉提
唐伟
马良
米尔扎提·艾莎
地里下提·阿不力孜
SHENG Jie;GU Fu-ding;Gulibike·Mulati;TANG Wei;MA Liang;Mierzhati·Aisha;Dilixiati·Abulizi(Department of Orthopaedics,Chest Hospital of Xinjiang Uyghur Autonomous Region,Urumqi 830049,China)
出处
《中国防痨杂志》
CAS
CSCD
2019年第4期394-398,共5页
Chinese Journal of Antituberculosis
基金
新疆维吾尔自治区卫生计生委青年医学科技人才专项科研项目(WJWY-201807).
关键词
结核
骨关节
微生物敏感性试验
分子探针技术
核酸扩增技术
评价研究
Tuberculosis,osteoarticular
Microbial sensitivity tests
Molecular probe techniques
Nucleic acid amplification techniques
Evaluation studies
