基于GeneXpert MTB/RIF技术的结核病检测策略效果分析

Effect of tuberculosis detection strategies based on GeneXpert MTB/RIF technology

目的探讨基于GeneXpert MTB/RIF技术(简称Xpert)的结核病检测策略,对提高结核病(MTB)病原学阳性检出率及缩短MTB检测周期、确诊周期方面的效果。方法以2015年—2020年宁波地区10家结核病定点医疗机构登记的20782例活动性肺结核患者的病案、实验室检测等信息为研究对象,深入分析宁波地区Xpert策略开展前后时间段的MTB病原学阳性检出情况、检测周期及确诊周期差异。结果采用基于Xpert技术检测策略的2018年—2020年活动性肺结核病例的病原学检测总阳性率(53.44%)高于未开展该策略的2015年—2017年病原学检测总阳性率(37.07%),差异有统计学意义(χ^(2)=562.149,P<0.05)。2018年—2020年,Xpert在肺结核病原学阳性病例检出中的贡献率从46.94%(322/686)提升至66.29%(875/1320),差异有统计学意义(χ^(2)=70.298,P<0.05)。2018年—2020年Xpert用于肺结核病原学检测的总阳性检出率为59.82%(1968/3290),高于单独采用涂片法的24.34%(3952/16237)及培养法的47.87%(4333/9052),差异有统计学意义(χ^(2)值分别为1629.954、137.888,P<0.05)。基于Xpert检测策略的开展可将MTB的检测周期和确诊周期由[4(1,22)]d和[5(1,12)]d缩短至[2(1,16)]d和[4(1,9)]d,差异有统计学意义(Z值分别为-28.202、-9.643,P<0.05)。结论采用基于Xpert技术的MTB检测策略能有效提升MTB病原学阳性率并能缩短MTB的检测周期和确诊周期,在MTB的早期发现、诊断方面具有较好的应用价值。

Objective This paper aims to explore the effect of tuberculosis detection strategy based on GeneXpert MTB/RIF technology(Xpert)on improving the positive etiological detection rate of tuberculosis(MTB)and shortening the detection cycle and diagnosis cycle of MTB.Methods Registered treatment files and laboratory test results of 20782 patients were enrolled in this study from 2015 to 2020.The differences of positive detection of MTB etiology,detection cycle and diagnosis cycle before and after Xpert strategy were analyzed in Ningbo.Results The total positive etiological rates of active pulmonary tuberculosis in the 2018-2020 based on Xpert strategy was(53.44%),which was higher than that(37.07%)in 2015-2017 without this strategy.The differences were statistically significant(χ^(2)=562.149,P<0.05).From 2018 to 2020,the contribution rate of Xpert in etiology-positive case increased from 46.94%(322/686)to 66.29%(875/1320)(χ^(2)=70.298,P<0.05).The positive rate of detection with Xpert was 59.82%(1968/3290),higher than those of smear(24.34%,3952/16237)and culture only(47.87%,4333/9052)(χ^(2)=1629.954,χ^(2)=137.888,P<0.05).Compared with the traditional phenotypic test,the MTB screening process based on Xpert could shorten the detection and diagnosis time from[4(1,22)]d,[5(1,12)]d to[2(1,16)]d and[4(1,9)]d,with the differences statistically significant(Z=-28.202,Z=-9.643,P<0.05).Conclusion The adoption of MTB detection strategy based on Xpert technology can effectively increase the positive rate of MTB in etiology and shorten the detection and diagnosis cycles of MTB,which has good application value in the early detection and diagnosis of MTB.