快速核酸检测系统用于肺结核临床诊疗的效果评价

史琰琰; 郑亦慧; 刘艳; 沈俭; 王胜难; 单灵莺; 戴俊华

doi:10.19428/j.cnki.sjpm.2020.19045

快速核酸检测系统用于肺结核临床诊疗的效果评价

GeneXpert MTB/RIF evaluated in diagnosis of pulmonary tuberculosis

摘要

摘要:
目的通过比较确诊肺结核患者的实验室检测结果，评价快速核酸检测系统（GeneXpert MTB/RIF）在肺结核临床诊疗的应用效果。
方法纳入2017年7月-2018年6月在上海市普陀区中心医院肺科门诊符合诊断标准的97名肺结核患者，开展痰涂片检查（Ziehl-Neelsen染色）、痰培养（MGIT液体培养）、XpertMTB/RIF检测，痰培养阳性者进行比例法药物敏感性试验和PNB法菌种鉴定，比较各方法的一致性。
结果GeneXpert结核分枝杆菌检测与细菌学检测相比，灵敏度为93.44%，特异度为55.55%，检测一致率为79.38%。GeneXpert结核分枝杆菌检测与PNB法菌种鉴定的一致率为94.55%。GeneXpert耐利福平检测与比例法药敏比较，灵敏度为66.67%，特异度为98.08%，两方法的一致率为96.36%。
结论GeneXpert MTB/RIF检测技术可与痰涂片和痰培养同时开展，提高确诊肺结核患者病原学阳性率，并尽早发现耐药肺结核患者。但仍需要进行菌种鉴定和药物敏感性试验，保证患者得到个体化治疗方案，获得最佳治疗效果。

Abstract:
ObjectiveTo evaluate GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis by comparing the lab results of diagnosed patients.
MethodsA total of 97 diagnosed pulmonary tuberculosis patients were enrolled from July 2017 to June 2018.Sputum smear microscopy (Ziehl-Neelsen stain), sputum culture (MGIT liquid culture) and Xpert MTB/RIF were conducted in all patients.Drug susceptibility test and strain identification by PNB were done for culture positive sputum samples.Consistency rate was calculated.
ResultsIn terms of M.tuberculosis detection, sensitivity and specificity of GeneXpert were 93.44% and 55.55%, respectively, compared with bacteriological examination (consistency rate 79.38%).Consistency rate of GeneXpert and PNB is 94.55%.In terms of RIF resistance test, sensitivity and specificity of GeneXpert were 66.67% and 98.08%, respectively, compared with phenotypic drug-susceptibility testing (consistency rate 96.36%).
ConclusionGeneXpert MTB/RIF can be utilized in combination with smear microscopy and liquid culture to diagnose more etiologically positive patients, and can spot RIF resistance patients early.But strain identification and drug susceptibility test are still needed for individualized therapy and optimal treatment outcome.

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