应用DNA微阵列芯片检测青年肺结核患者结核菌耐药性的研究

Study on DNA microarray test for detection of drug resistance in young patients with pulmonary tuberculosis

目的:以结核菌比例法药敏试验为标准,分析DNA微阵列芯片(以下简称DNA微阵列)在聊城市青年肺结核患者痰标本中进行结核分枝杆菌异烟肼和利福平耐药性检测的效能。方法:选取聊城市2019年10月-2021年9月确诊的18~45岁的青年肺结核患者,对其中痰涂片抗酸杆菌阳性的215例患者,通过DNA微阵列和比例法药敏对痰标本进行异烟肼和利福平的耐药性检测,分析DNA微阵列对异烟肼、利福平、耐多药结核诊断的敏感性、特异性、阳性预测值和阴性预测值,并与比例法进行一致性比较。结果:DNA微阵列检测耐多药结核的敏感度和特异度分别为71.4%和99.0%,阳性预测值和阴性预测值分别为83.3%和98.0%,Kappa=0.75,说明两种方法在耐多药结核检测中有高度一致性。DNA微阵列检测异烟肼耐药性的敏感度和特异度分别为76.5%和97.2%,阳性预测值和阴性预测值分别为83.9%和95.7%,Kappa=0.76,说明两种方法在异烟肼耐药性检测中有高度一致性。DNA微阵列检测利福平耐药性的敏感度和特异度为82.1%和98.9%,阳性预测值和阴性预测值分别为92.0%和97.4%,Kappa=0.85,说明两种方法在利福平耐药性检测中基本一致。结论:DNA微阵列适用于青年结核患者快速筛查和耐药性检测,为聊城青年结核病的防控能提供有力支持。

Objective:To evaluate the efficiency of a DNA microarray chip assay in detecting isoniazid and rifampicin drug resistance in sputum samples from young tuberculosis patients in Liaocheng city,proportion method for drug sensitivity test was used as the reference standard.Methods:We selected 215 patients who was confirmed youth tuberculosis with positive sputum smear aged 18 to 45 from October 2019 to September 2021 in Liaocheng city,collected their sputum samples to do DNA microarray test and proportion method for drug susceptibility test.The sensitivity,specificity positive and negative predictive value of the DNA microarray test in detecting drug resistance to isoniazid,rifampicinand MDR-TB were evaluated,Kappa test was used to compare the consistency of the two tests.Results:The sensitivity,specificity,positive and negative predictive value were 71.4%,99.0%,83.3%,98.0%respectively,in the DNA microarray test for MDR-TB,Kappa=0.75,which indicated the value of the DNA microarray test had highly consistent with actual value.The sensitivity,specificity,positive and negative predictive value were 76.5%,97.2%,83.9%,95.7%respectively,in the DNA microarray test for isoniazid drug resistance Kappa=0.76,which indicated the value of the DNA microarray test had highly consistent with actual value.The sensitivity,specificity,positive and negative predictive value were 82.1%,98.9%,92.0%,97.4%respectively,in the DNA microarray test for rifampin drug resistance Kappa=0.85,which indicated the value of the DNA microarray test had almost completely consistent with actual value.Conclusion:The DNA microarray chip assay was suitable as a first-line screening assay in detecting tuberculosis and drug resistance,it could provide a favorable condition for the prevention and control of tuberculosis among young people in Liaocheng.