GeneXpert MTB/RIF技术在勐海县肺结核快速诊断及耐药结核筛查中的应用

Application of GeneXpert MTB/RIF Technology in Rapid Diagnosis of Tuberculosis and Drug-Resistant Tuberculosis Screening in Menghai County

目的评价GeneXpertMTB/RIF检测技术在肺结核高发地区勐海县快速诊断肺结核及利福平(RIF)耐药筛查中的应用价值。方法回顾性分析2017年8月—2018年4月在勐海县人民医院感染科就诊的500例临床诊断肺结核患者,同时进行痰抗酸菌涂片及痰液GeneXpertMTB/RIF检测。评估GeneXpertMTB/RIF检测系统在勐海县可疑肺结核患者中结核分枝杆菌检出率和RIF耐药患者检出率。结果 500例患者中GeneXpertMTB/RIF检测出结核分枝杆菌113例,阳性率为22.6%,阳性率高于痰抗酸染色涂片,两者之间的差异有统计学意义(χ~2=5.853,P<0.05)。检测出RIF耐药9例,耐药率7.96%,在痰涂片阳性患者中GeneXpertMTB/RIF检出率为91.00%,在痰涂片阴性患者中GeneXpertMTB/RIF检出率为15.82%,差异有统计学意义(χ~2=52,P<0.05),痰涂片阳性患者中RIF耐药检出率为12.2%,痰涂片阴性患者中RIF耐药检出率为5.56%,差异无统计学意义(χ~2=2.483,P>0.05)。结论GeneXpertMTB/RIF能够极大提高肺结核高发地区的基层医疗机构对结核病的快速诊断水平,及时发现RIF耐药患者,控制肺结核传播。

Objective To evaluate the application value of GeneXpertMTB/RIF detection technology in rapid diagnosis of tuberculosis and rifampicin(RIF)drug resistance screening in Menghai area with high incidence of tuberculosis.Methods A retrospective analysis of 500 patients with clinically diagnosed pulmonary tuberculosis who were admitted to the Department of Infectious Diseases of the People's Hospital of Menghai County from August 2017 to April,2018,and simultaneous sputum sputum smear and sputum GeneXpertMTB/RIF test.To evaluate the detection rate of Mycobacterium tuberculosis and the detection rate of RIF-resistant patients in suspected tuberculosis patients in Menghai County by GeneXpertMTB/RIF detection system.Results Of the 500 patients,113 cases of Mycobacterium tuberculosis were detected by GeneXpertMTB/RIF,the positive rate was 22.6%,and the positive rate was higher than that of sputum antacid staining smear.The difference between the two was statistically significant(χ^2=5.853,P<0.05).9 cases of RIF resistance were detected,and the drug resistance rate was 7.96%.The detection rate of GeneXpertMTB/RIF was 91.00%in sputum smear-positive patients,and the rate of GeneXpertMTB/RIF was 15.82%in sputum smear-negative patients,with statistical significance(χ^2=52,P<0.05),the detection rate of RIF resistance in sputum smear-positive patients was 12.2%,and the detection rate of RIF resistance in sputum smear-negative patients was 5.56%.The difference was not statistically significant,(χ^2=2.483,P>0.05).Conclusion GeneXpertMTB/RIF can greatly improve the rapid diagnosis of tuberculosis in primary care institutions with high incidence of tuberculosis,timely detect RIF-resistant patients,and control the spread of tuberculosis.