核酸检测指导个体化耐药脊柱结核治疗

Preliminary evaluation of the efficacy of Xpert MTB/RIF guided individualized chemotherapy for rifampicin-resistant/multi-drug-resistant spinal tuberculosis

[目的]评价Xpert MTB/RIF指导的个体化化疗治疗耐利福平/耐多药脊柱结核的初步临床疗效。[方法]回顾分析2017年6月~2018年6月120例接受手术治疗的脊柱结核患者,术后参照既往抗结核化疗史及Xpert MTB/RIF检测结果,制定个体化化疗方案,待表型药敏结果回示后根据药敏结果再次调整化疗方案。[结果]120例患者中,Xpert MTB/RIF检测结核分枝杆菌阳性79例(65.83%),BACTEC MGIT 960系统培养阳性48例(40.00%),差异具有统计学意义(P<0.05)。Xpert MTB/RIF检出11例发生rpoB基因突变,其中6例表型药敏证明利福平耐药,但1例Xpert MTB/RIF检测阴性患者表型药敏证明利福平耐药。术后各随访时间点,11例患者的红细胞沉降率、C反应蛋白逐渐下降至正常水平。3例出现肝功能损害,5例出现高尿酸血症,对症治疗后上述指标均恢复正常。末次随访骨融合良好,平均融合时间(5.66±2.57)个月。无窦道、冷脓肿、内固定失效、假关节形成等并发症。[结论]基于XpertMTB/RIF指导的个体化化疗方案有利于尽早治愈耐利福平/耐多药脊柱结核,避免治疗失败及其他严重并发症。

[Objective]To evaluate the preliminary clinical efficacy of Xpert MTB/RIF guided individualized chemotherapy for rifampicin-resistant/multi-drug resistant spinal tuberculosis.[Methods]A retrospective study was conducted on 120 patients who received surgical treatment for spinal tuberculosis from June 2017 to June 2018.After the surgery,the individualized antituberculosis chemotherapy scheme was formulated based on the previous anti-tuberculosis chemotherapy history and results of Xpert MTB/RIF test,and adjusted again according to the results of phenotype drug sensitivity results.[Results]Among the 120 patients,79 patients(65.83%)achieved positive results of Xpert MTB/RIF for mycobacterium tuberculosis,whereas 48 patients(40.00%)got positive results of BACTEC MGIT 960 liquid culture system for mycobacterium,which was of statistical significance(P<0.05).In addition,the Xpert MTB/RIF detected 11 cases of rpoB gene mutation,among which 6 patients were proved rifampicin resistance by phenotypic drug sensitivity,whereas 1 patient with negative result of Xpert MTB/RIF test proved rifampicin resistance.As time went during follow-up period,the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)decreased gradually to normal levels in 11 patients.However,liver dysfunction was noted in 3 patients and hyperuricemia was found in 5 patients,which all improved after corresponding symptomatic treatment.To the latest follow up,all the patients got bony fusion of the involved segment in mean time of(5.66±2.57)months.No complications,such as sinus,implant failure and pseudarthrosis were found in anyone of them.[Conclusion]The individualized antituberculosis chemotherapy based on Xpert MTB/RIF assay facilitate to cure rifampicin-resistant/multi-drug resistant tuberculosis early and avoid severe complications.