Xpert MTB/RIF技术在诊断肺结核及利福平耐药的临床价值

Clinical value of Xpert MTB/RIF in diagnosis of pulmonary tuberculosis and rifampicin resistance in different grade specimens

目的评估Xpert MTB/RIF技术在快速诊断肺结核及利福平耐药的临床应用价值。方法收集肺结核患者痰标本420例,同时进行涂片法、MGIT液体培养法(简称"液培法")+微孔板比例法药敏试验((简称"药敏法")及Xpert MTB/RIF检测结核分枝杆菌(Mtb)和利福平耐药。分别以液培法和药敏法为金标准,分析Xpert MTB/RIF检测Mtb和利福平耐药的效能,比较不同方法检测Mtb和利福平耐药的阳性检出率。结果 Xpert MTB/RIF和涂片法检测Mtb的灵敏度为84. 80%、30. 40%(P <0. 05),特异度为78. 82%、98. 82%((P <0. 05)。Xpert MTB/RIF检测利福平耐药的灵敏度为100. 00%,特异度为97. 65%。Xpert MTB/RIF检测Mtb阳性检出率为59. 05%,涂片法为18. 57%(P <0. 05),液培法为59. 52%(P> 0. 05)。Xpert MTB/RIF检测利福平耐药阳性检出率为21. 70%,药敏法为19. 81%(P> 0. 05)。结论与传统涂片法和液培法及药敏试验比,痰标本中Xpert MTB/RIF技术检测Mtb尤其是检测利福平耐药具有较高的敏感度、特异度,时间短,准确性高,一致性较好,对肺结核早期诊断与治疗有重要意义。

Objective To evaluate the clinical value of Xpert MTB/RIF technology in rapid diagnosis of pulmonary tuberculosis and rifampicin resistance in different grade specimens.Methods 420 sputum specimens from patients with pulmonary tuberculosis were collected.At the same time,smear method,MGIT liquid culture method(“liquid culture method”)+microplate proportion method drug sensitivity test(“drug sensitivity method”)and Xpert MTB/RIF were used to detect Mycobacterium tuberculosis(Mtb)and rifampin resistance.The efficacy of Xpert MTB/RIF in detecting Mtb and rifampicin resistance was analyzed by liquid culture and drug sensitivity,and the positive rate of Mtb and rifampicin resistance was detected by different methods.Results The sensitivity of Xpert MTB/RIF and smear method to detect Mtb was 84.80%,30.40%(P<0.05),and the specificity was 78.82%and 98.82%(P<0.05).The sensitivity and specificity of Xpert MTB/RIF for rifampicin resistance were 100%and 97.65%respectively.The positive rate of detection of Mtb by Xpert MTB/RIF was 59.05%,smear method was 18.57%(P<0.05),and liquid culture method was 59.52%(P>0.05).The positive rate of rifampin resistance detected by Xpert MTB/RIF was 21.70%,and drug sensitivity method was 19.81%(P>0.05).Conclusion Compared with traditional smear method and liquid culture method and drug sensitivity test,Xpert MTB/RIF technique in sputum specimens has the advantages of high sensitivity,specificity,short time,high accuracy and good consistency.It is of great significance to the early diagnosis and treatment of pulmonary tuberculosis,which is worthy of widely clinical popularization.