基因芯片技术检测分枝杆菌和异烟肼、利福平耐药性在结核性脓胸诊断中的应用

Gene chip technology for detecting mycobacteria and Mycobacterium tuberculosis resistance of isoniazid and rifampin in the application of tuberculous empyema

目的探讨基因芯片技术检测分枝杆菌和异烟肼(INH)、利福平(RFP)耐药性在结核性脓胸诊断中的临床应用价值。方法收集2011年1月至2015年12月临床疑似结核性脓胸患者182例的脓液标本,分别应用基因芯片技术和快速培养法进行检测,比较两种方法的特异性和敏感性;同时选取36例临床确诊为结核性脓胸患者,且基因芯片法和MGIT培养法均为阳性的标本进行INH、RFP耐药性检测。以MGIT培养法的药敏结果为标准,评价基因芯片法的灵敏度、特异度和符合率。结果 182例疑似结核性脓胸患者中,135例临床确诊为结核性脓胸,基因芯片法和快速培养法的特异性均为95.7%(45/47),灵敏度分别为48.9%(66/135)和26.7%(36/135),二者比较有统计学差异(χ2=80.5,P<0.05)。基因芯片法检测RFP耐药性灵敏度、特异度和符合率均为100%;而检测INH耐药性的灵敏度、特异度和符合率分别为50.0%(1/2)和97.1%(33/34)和94.4%。结论基因芯片技术检测分枝杆菌具有较高的、特异性,可快速鉴别出非结核分枝杆菌,且可有效检测结核分枝杆菌异烟肼和利福平的耐药性,对结核性脓胸的早期诊断与治疗有重要意义。

To evaluate the clinical value of gene chip technology（GCT）in detecting the mycoba-cteria,isoniazid and rifampin resistance of patients diagnosed tuberculous empyema.The 182 patients who met the inclusion criteria were enrolled to this study from January 2011 to December 2015,whose pus mycobacterial species were detected by GCT and MGIT,the simultaneous and sensitivity of them were compared.Meanwhile,36 patients diagnosed tuberculous empyema were selected to detect isoniazid and rifampin resistance.The simultaneous and sensitivity of GCT were evaluated base on the standard of MGIT.The 135 patients were diagnosed by tuberculous empyema.The specificity of GCT was same to MGIT（95.7%）,the the sensitivity was 48.9%（66/135）in GCT,26.7% in MGIT,there was significant difference between them（χ~2=80.5,P〈0.05）.The sensitivity,specificity and coincidence rate of GCT in rifampin resistance were 100%,the sensitivity,specificityand coincidence rate in INH were 50.0%（1/2）,97.1%（33/34）and 94.4%.Gene chip technology for detection of mycobacteria has high sensitivity and specificity,which can identify non-tuberculous mycobacteria quickly.And it can also effectively detect the resistance of Mycobacterium tuberculosis to isoniazid and rifampicin.It has important significance in early diagnosis and treatment of tuberculous empyema.