摘要
目的 分析GeneXpert结核分枝杆菌及利福平耐药(Mycobacterium tuberculosis/rifampicin resistance, MTB/RIF,简称GeneXpert)检测诊断对结核分枝杆菌检测的准确性、可行性及利福平耐药rpoB基因的突变特征。方法 选择三亚市结核病定点医院2015-2021年诊断的可疑肺结核患者痰样本(4 234份),同时进行痰涂片、固体培养、固体比例法药敏试验和GeneXpert检测。结果 4 234份痰样本痰涂片、固体培养和GeneXpert检测,阳性检出率分别为29.24%(1 238/4 234)、32.17%(1 362/4 234)、35.40%(1 499/4 234),GeneXpert法检测的阳性率较痰涂片高,差异有统计学意义(χ^(2)=36.775,P<0.01);与固体培养法比较,差异无统计学意义(χ^(2)=9.908,P=0.02)。以固体培养结果为金标准,GeneXpert检测方法检测结核分枝杆菌(Mycobacterium tuberculosis, MTB)的灵敏度和特异度分别为91.04%(1 240/1 362)和90.98%(2 613/2 872)。以比例法药敏试验结果为金标准,GeneXpert法对利福平耐药的灵敏度和特异度分别为96.96%(96/99)和98.86%(1 128/1 141),一致率为98.71%;GeneXpert无探针突变组利福平耐药准确度明显低于有探针突变组;初治和复治病例的探针突变频率差异有统计学意义。对rpoB基因突变频率特征分析:探针E(50.00%)>探针A(22.12%)>探针D(14.42%)>探针B(6.73%)>联合探针(5.77%)>探针C(0.96%)。结论 GeneXpert检测能快速有效地诊断耐利福平结核病,有助于临床早期诊断和治疗。本地区耐利福平结核病rpoB基因突变探针主要发生在探针E和探针A,探针C突变最少。
Objective To analyze the accuracy and feasibility of GeneXpert MTB/RIF(GeneXpert)detection in the detection of Mycobacterium tuberculosis and the characteristics of rifampicin-resistant rpoB gene mutations.Methods A total of 4234 sputum samples from suspected tuberculosis patients diagnosed in Sanya tuberculosis designated hospitals from 2015 to 2021 were selected and subjected to sputum smear,solid culture,drug sensitivity test by solid proportion method and GeneXpert detection.Results The positive detection rates of sputum smear,solid culture and GeneXpert of 4234 sputum samples were 29.24%(1238/4234),32.17%(1362/4234)and 35.40%(1499/4234),respectively.The positive detection rate of GeneXpert was higher than that of sputum smear,and the difference was statistically significant(χ^(2)=36.775,P<0.01).It was slightly higher than solid culture,and the difference was not statistically significant(χ2=9.908,P=0.02).Taking solid culture results as the gold standard,the sensitivity and specificity of GeneXpert for detecting MTB were 91.04%(1240/1362)and 90.98%(2613/2872),respectively.According to the proportional drug susceptibility test results as the gold standard,the sensitivity and specificity of GeneXpert in detecting rifampicin resistance were 96.96%(96/99)and 98.86%(1128/1141),respectively,with the consensus rate of 98.71%.The accuracy of rifampicin resistance in GeneXpert group without probe mutation was significantly lower than that in group with probe mutation.There was a statistical difference in probe mutation frequency between newly treated and retreated cases.The analysis of rpoB gene mutation frequency characteristics showed:Probe E(50.00%)>Probe A(22.12%)>Probe D(14.42%)>Probe B(6.73%)>combined probe(5.77%)>Probe C(0.96%).Conclusions GeneXpert detection can quickly and effectively diagnose rifampicin-resistant tuberculosis,which is helpful for early clinical diagnosis and treatment.In this region,the rpoB gene mutation probes of rifampicin-resistant tuberculosis mainly occurr in Probe E and Probe A,with
作者
林永通
麦世康
黄隆
黎永华
王冠瑜
陈丽翠
LIN Yongtong;MAI Shikang;HUANG Long;LI Yonghua;WANG Guanyu;CHEN Licui(Sanya Center for Disease Control and Prevention,Sanya,Hainan 572000,China;Sanya Dermatology and Mental Health Prevention and Treatment Center,Sanya,Hainan 572000,China)
出处
《中国热带医学》
CAS
2023年第7期748-753,共6页
China Tropical Medicine
