基因芯片法检测宁波地区结核分枝杆菌耐药性的研究

Study of drug resistance of Mycobacterium tuberculosis by gene chip in Ningbo area

目的评价基因芯片法检测结核分枝杆菌(MTB)对利福平和异烟肼耐药性的效能。方法纳入痰液涂片阳性肺结核病患者278例,采用基因芯片法检测MTB对利福平和异烟肼的耐药性,对检测效能进行评价。结果基因芯片法检测涂阳肺结核患者利福平耐药性的灵敏度、特异度分别为68.18%、95.73%,与液体培养法差异无统计学意义(P>0.05),检测灵敏度随着涂阳等级差异无统计学意义(χ^(2)趋势=3.39,P=0.066)。检测异烟肼耐药性的灵敏度、特异度分别为45.45%、99.00%,与液体培养法差异有统计学意义(P<0.05),特别是≤3+涂阳等级的患者。检测耐多药的灵敏度、特异度分别为57.50%、97.48%,与液体培养法差异有统计学意义(χ^(2)=4.35,P=0.035)。结论基因芯片法检测涂阳肺结核患者利福平耐药性的真实性和可靠性较好,但对异烟肼耐药性和耐多药的效果不佳,特别是涂片阳性等级较低者容易发生漏检。

Objective To evaluate the efficacy of gene chip in detecting rifampicin and isoniazid resistance ofMycobacterium tuberculosis(MTB).Methods A total of 278 patients with sputum smear positive pulmonary tuberculosis were enrolled in the study.The drug resistance of MTB to rifampicin and isoniazid was detected by gene chip method.The detection efficiency of gene chip method was evaluated.Results The sensitivity and specificity of gene chip method in detecting rifampicin resistance in smear positive pulmonary tuberculosis patients were 68.18%,95.73%.There was no statistical significance on the difference between gene chip method and liquid culture method(P>0.05).The detection sensitivity tended to increase with the increase of positive grade,with the difference not statistically significant(χ_(tendency)^(2)=3.39,P=0.066).The sensitivity and specificity of gene chip method in detecting isoniazid resistance were 45.45%and 99.00%,respectively.There was significant differences between gene chip method and liquid culture method(P<0.05),especially for≤3 positive smear positive grade.The sensitivity and specificity of MDR detection were 57.50%and 97.48%,respectively,with the difference statistically significant compared with those of liquid culture method(χ^(2)=4.35,P=0.035).Conclusion The authenticity and reliability of gene chip method in detecting rifampicin resistance of smear positive pulmonary tuberculosis patients are acceptable,but the detection effect of isoniazid resistance and multidrug resistance is poor,especially for those with low smear positive grade prone to be misdiagnosed.