Xpert MTB/RIF在快速诊断肺结核及利福平耐药中的临床应用

Application of Xpert MTB/RIF assay on rapid detection of MTB and rifampin-resistant

目的探讨利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)在肺结核诊断及其耐药性检测中的临床应用价值。方法收集408例结核患者标本,同时采用抗酸染色法、固体培养法及Xpert MTB/RIF检测,并对其结果进行分析比较。结果 408例标本抗酸染色法、固体培养法和Xpert MTB/RIF检测出结核分枝杆菌的阳性率分别为25.00%(102/408)、42.16%(172/408)和58.09%(237/408)。经统计学分析,Xpert MTB/RIF阳性率高于抗酸染色法和固体培养法,差异均有统计学意义(P<0.05)。其中,固体培养法和Xpert MTB/RIF检测均为阳性的标本共168例,经比例法药物敏感试验与Xpert MTB/RIF检测利福平耐药率分别为26.19%(44/168)和27.38%(46/168),2种方法耐药率比较,差异无统计学意义(P>0.05),以比例法药敏试验作为金标准,Xpert MTB/RIF检测利福平耐药的敏感度为97.73%(43/44),特异性为97.58%(121/124)。结论 Xpert MTB/RIF可快速、准确检测结核分枝杆菌及利福平耐药性,具有重要的临床应用价值。

Objective To investigate clinical value of Xpert MTB/RIF assay on rapid detection of MTB and rifampin-resistant.Methods 408 cases of tuberculosis were detected by acid-fast stain,Solid culture and Xpert MTB/RIF,the results were compared.Results All the samples were detected by acid-fast stain,culture and Xpert MTB/RIF assay,the positive rates were 25.00%（102/408）,42.16%（172/408）and 58.09%（237/408）,respectively.The positive rates of Xpert MTB/RIF assay were higher than acidfast stain and culture method,and the difference is statistically significant（P〈0.05）.There are 168 cases of specimen which were tested positively by both culture and Xpert MTB/RIF,the RIF resistance rates from standard drug susceptibility testing and Xpert MTB/RIF assay respectively were 26.19%（44/168）and 27.38%（46/168）,and had no statistical significance（P〈0.05）.According to the result of drug susceptibility with proportion method,the sensitivity and specificity of Xpert MTB/RIF in detecting RIF resistance were 97.73%（43/44）and 97.58%（121/124）.Conclusion Xpert MTB/RIF can quickly and accurately detect MTB and RIF resistance,it has important clinical significance.