Xpert MTB/RIF技术在肠结核诊断的临床应用观察

Application of rifampicin-resistant real-time fluorescence quantitative nucleic acid amplification in diagnosis of intestinal tuberculosis

目的通过对利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)的临床应用观察,评估快速诊断肠结核及对利福平耐药性诊断的价值。方法选取2017年12月至2019年1月于本院消化内镜中心查结肠镜提示溃疡或隆起性病变黏膜标本38例,并通过抗酸染色,结核分枝杆菌的快速培养和Xpert MTB/RIF方法检测所有肠黏膜标本研磨液;根据临床诊断标准,评价3种检验方法诊断肠结核的敏感性、特异性、一致率及Xpert MTB/RIF检测利福平耐药性的效能。结果 38例患者中,确诊肠结核17例,非肠结核21例;抗酸染色,960结核分枝杆菌快速培养和Xpert技术的灵敏度分别为17.65%(3/17)、52.94%(9/17)、70.59%(12/17);特异度均为100.00%。Xpert技术对诊断肠结核的敏感性显著高于抗酸染色(P=0.049);等同于快速培养(P=0.606);3组特异性比较差异无统计学意义;Xpert MTB/RIF检测结核分枝杆菌利福平耐药性结果均敏感。结论 Xpert技术对肠黏膜标本中结核分枝杆菌的检测具有高灵敏度和特异度,可检测出利福平耐药性,推荐用于肠结核的快速诊断及早期治疗。

Objective To evaluate the value of rifampicin-resistant real-time fluorescence quantitative nucleic acid amplification in rapid diagnosis of intestinal tuberculosis and rifampicin resistance by observing its clinical application.Methods 38 cases of mucosa specimerns with ulceration or swelling lesions were collected from the colonoscopy examination in the digestive endoscopy examination in the digestive endoscopy center of our hospital from December 2017 to January 2019,The intestinal mucosa abrastve fluid were tested by acid-faststain,MGIT960 liquid culture and Xpert technique method at the same time.According to clinical diagnostic criteria,the sensitivity,specificity and consistercy of the three methods for diagnose of interstinal tuberculosis were evaluated,and the efficacy of Xpert in the detection of rifampicin resistance was evaluated.Results Of the 38 patients,17 were diagnosed as intestinal tuberculosis and 21 as non-intestinal tuberculosis.The sensitivity of acid-faststain,MGIT960 liquid culture and Xpert technique were respectively 17.65%,52.94%,70.59%,the specificity was 100%.The correspondencerate of Xpert were 86.84%.The sensitivity of Xpert technique in the diagnosis of intestinal tuberculosis was better than that of acid-fast staining(P=0.049),which was equivalent to MGIT960 liquid culture(P=0.606).There was no singnificant difference in specificity among the three groups.Detection of rifampicin resistance in Mycobacterium tuberculosis by Xpert technique is sensitive.Xpert was sensitive to rifampicin resistance of Mycobacterium tuberculosis.Conclusion Xpert technique has high sensitivity and specificity for the detection of Mycobacterium tuberculosis in intestinal mucosa specimens,and can detect rifampicin resistance.It is recommended for rapid diagnosis and early treatment of intestinal tuberculosis.