基因芯片法与线性探针法对痰标本中结核分枝杆菌检测的应用价值

Application value of gene chip method and linear probe method in detecting Mycobacterium tuberculosis in sputum specimens

目的探讨基因芯片法与线性探针法检测痰标本中结核分枝杆菌(MTB)的应用价值。方法海南医学院第二附属医院2018年3—7月门诊和住院的106例疑似肺结核患者纳入研究,采用基因芯片法、线性探针法对患者送检的痰进行检测,并与改良罗氏培养法进行比较;以比例法药敏试验为金标准,分析上述两种方法检测利福平和异烟肼耐药性的效能。结果对106份痰标本进行改良罗氏培养,阳性率为52.83%(56/106),经鉴定其中46份标本为MTB阳性。基因芯片法和线性探针法分别检出MTB46、53株,基因芯片法、线性探针法与改良罗氏培养法检测MTB结果比较,差异均无统计学意义(均P>0.05)。基因芯片法、线性探针法与比例法检测MTB对利福平的耐药性比较,差异均无统计学意义,且具有较好一致性(均P>0.05,均Kappa>0.75)。对利福平的耐药性检测,基因芯片法的灵敏度、特异度分别为84.62%、90.00%,线性探针法分别为84.62%、85.00%。基因芯片法、线性探针法与比例法检测MTB对异烟肼的耐药性比较,差异均无统计学意义,但一致性一般(均P>0.05、均Kappa<0.75)。对异烟肼的耐药性检测,基因芯片法的灵敏度、特异度分别为69.23%(18/26)、95.00%(19/20),线性探针法分别为65.38%(17/26)、85.00%(17/20)。结论基因芯片法和线性探针法均可准确、快速地从大部分疑似结核病患者的痰标本中鉴定出MTB,也适用于利福平和异烟肼耐药结果的快速检测,从而指导临床用药,值得临床推广。

Objective To explore the application value of gene chip method and linear probe method in detecting Mycobacterium tuberculosis(MTB)in sputum specimens.Methods 106 suspected pulmonary tuberculosis outpatients and inpatients in the Second Affiliated Hospital of Hainan Medical University in March-July 2018 were enrolled in the study,sputum specimens were detected by gene chip method and linear probe method,then compared with the modified Roche culture method;proportional susceptibility test was as gold standard to analyze the efficacy of above two methods in detection of rifampicin and isoniazid resistance.Results 106 sputum specimens were cultured by modified Roche culture method,positive rate was 52.83%(56/106),46 specimens were identified as MTB positive.46 and 53 strains of MTB were detected by gene chip method and linear probe method respectively,there was no significant difference in MTB detection results between gene chip method,linear probe method,and modified Roche culture method(all P>0.05).There was no significant difference but good consistency in detection of rifampicin resistance of MTB between gene chip method,linear probe method,and proportional method(all P>0.05,all Kappa>0.75).For rifampicin resistance detection,the sensitivity and specificity of gene chip method were 84.62%and 90.00%respectively,and the linear probe method were 84.62%and 85.00%respectively.There was no significant difference but general consistency in detection of isoniazid resistance of MTB between gene chip method,lin-ear probe method,and proportional method(all P>0.05,all Kappa<0.75).For isoniazid resistance detection,the sensitivity and specificity of gene chip method were 69.23%(18/26)and 95.00%(19/20)respectively,linear probe method were 65.38%(17/26)and 85.00%(17/20)respectively.Conclusion Both gene chip method and linear probe method can accurately and rapidly identify MTB from sputum specimens of most suspected tuberculosis patients,they can also be used for rapid detection of rifampicin and isoniazid resistance,thus guiding clinical antimicrobial use,which are worthy of clinical promotion.