扩大GeneXpert MTB检测范围对病原学阳性及耐药肺结核患者发现率的影响

The impact of expanding GeneXpert MTB detection range on the detection rate of pathogenic positive and drug⁃resistant pulmonary tuberculosis patients

目的评价扩大GeneXpert MTB检测范围对病原学阳性结核病患者及利福平耐药结核病患者发现率的影响。方法从中国疾病预防控制信息系统子系统结核病信息管理系统收集2019—2022年徐州市、南通市、泰州市及镇江市4个设区市22家结核病定点医疗机构登记的22941例活动性肺结核患者的实验室检测、药敏检测等信息,分析2次扩大GeneXpert MTB检测范围,采用3种检测模式结果的差异。结果2019年经分枝杆菌涂片、培养及影像学诊断为活动性肺结核患者后,全部开展GeneXpert MTB(模式A),2020—2021年对非定点医院转诊的肺结核疑似患者采用GeneXpert MTB检测(模式B),2022年对定点医院结核门诊所有肺结核疑似患者采用GeneXpert MTB检测(模式C),以上3种模式中县级结核病定点医院发现的利福平耐药结核病患者,均转至市级结核病定点医院进一步诊断和治疗。2019—2022年4市登记的活动性肺结核患者病原学阳性率逐年提高,分别为56.07%、57.31%、59.03%、67.92%。;肺结核患者3种检测模式阳性检出率分别为56.07%、58.13%、67.92%,差异有统计学意义(χ^(2)=179.30,P<0.01);涂阴肺结核患者采用GeneXpert MTB检测,3种检测模式阳性检出率分别为25.91%、28.39%、47.70%,差异有统计学意义(χ^(2)=446.23,P<0.01);肺结核患者3种检测模式利福平耐药结核病发现率分别为2.16%、2.05%、2.16%,差异无统计学意义(χ^(2)=0.38,P=0.83)。结论通过推广GeneXpert MTB检测技术,肺结核患者病原学阳性检出率得到显著提升,对疾病防控有重要的意义,但扩大检测范围并提高利福平耐药结核病的发现率。

Objective To evaluate the impact of expanding GeneXpert MTB detection range on the detection rate of pathogenic positive and drug⁃resistant pulmonary tuberculosis patients.Methods The laboratory test,drug resistance test and other information of 22941 active pulmonary tuberculosis patients registered in 22 designated tuberculosis medical institutions in Xuzhou,Nantong,Taizhou and Zhenjiang from 2019 to 2022 were collected from the tuberculosis Information Management System,a subsystem of the China Dis⁃ease Prevention and Control Information System,and the results of 3 test methods were analyzed for 2 time expanding of detection range of GeneXpert MTB method.Results After being diagnosed with active pulmonary tuberculosis by Mycobacterium smear,culture,and imaging in 2019,all patients were subjected to GeneXpert MTB testing(Mode A);From 2020 to 2021,suspected pulmonary tuberculo⁃sis patients referred to non⁃designated hospitals were taken GeneXpert MTB testing(Mode B);In 2022,all suspected pulmonary tuber⁃culosis patients in designated hospital tuberculosis clinics underwent GeneXpert MTB testing(Mode C).In above 3 modes,rifampicin resistant tuberculosis patients identified in county level tuberculosis designated hospitals were transferred to municipal tuberculosis des⁃ignated hospitals for further diagnosis and treatment.From 2019 to 2022,the positive rates of active pulmonary tuberculosis patients reg⁃istered in 4 cities increased year by year,which were 56.07%,57.31%,59.03%,and 67.92%,respectively.The positive detection rates of the 3 modes were 56.07%,58.13%,and 67.92%,respectively,with statistically significant differences(χ^(2)=179.30,P<0.01);Patients with smear negative pulmonary tuberculosis were tested using GeneXpert MTB,and the positive detection rates of the three detection modes were 25.91%,28.39%,and 47.70%,respectively,with statistically significant differences(χ^(2)=446,P<0.01);The detection rates of Rifampicin resistant tuberculosis in the three detection modes were 2.16%,2.05%and 2.16%respectively,with no statistically significant difference(χ^(2)=0.38,P=0.83).Conclusions Through the promotion of GeneXpert MTB detection technol⁃ogy,the positive detection rate of the etiology of pulmonary tuberculosis patients has been significantly improved,resulting fast tracking of the infection source at early stage,which is of great significance for disease prevention and control.However,this detection technology cannot effectively improve the detection rate of rifampicin resistant tuberculosis.