GeneXpert MTB/RIF检测技术在结核病诊断及利福平耐药中的应用效果

Application and effect of GeneXpert MTB/RIF in diagnosis of tuberculosis and detection of rifampicin resistance

目的探讨GeneXpert MTB/RIF检测技术在句容市基层定点医院结核病诊断和利福平耐药中的应用效果。方法回顾性分析2022年2月-12月句容市结核定点医院收治的182例肺结核患者病例情况,并从句容市结核实验室获得检测数据,以痰培养及体外比例法药敏试验为金标准,分析GeneXpert MTB/RIF检测结核分枝杆菌和利福平耐药的灵敏度和特异度,以及与金标准的一致率。结果182份痰标本经痰涂片、痰培养和GeneXpert MTB/RIF检测,阳性率分别为38.46%(70/182)、55.49%(101/182)和54.95%(100/182)。以痰培养结果为金标准,GeneXpert MTB/RIF检测灵敏度为86.14%(87/101),特异度为87.65%(71/81)。GeneXpert MTB/RIF与痰培养检测结果一致率为86.81%(158/182)。GeneXpert MTB/RIF检测涂阳患者结核分枝杆菌的敏感度和特异度分别为91.80%(56/61)、66.67%(6/9),检测涂阴患者敏感度和特异度分别为77.50%(31/40)、90.28%(65/72)。以体外比例法药敏试验为金标准,GeneXpertM TB/RIF检测痰培养阳性患者中利福平耐药的灵敏度为83.33%(5/6),特异度为97.87%(92/94),检测结果一致率为97.00%(97/100)。结论GeneXpert MTB/RIF检测技术在对结核病的早期诊断及利福平耐药有较好的应用效果,适合在基层结核病定点医院大规模推广。

Objective This paper aims to explore the application and effect of GeneXpert MTB/RIF in the diagnosis of tuberculosis and the detection of rifampicin resistance in the designated grass-roots hospitals in Jurong City.Methods A retrospective analysis was conducted on 182 cases of pulmonary tuberculosis admitted to designated tuberculosis hospitals in Jurong City from February 2022 to December 2022.Test data were obtained from the tuberculosis laboratory in Jurong City,and sensitivity and specificity of GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis and rifampicin resistance,as well as the consistency with the gold standard,were analyzed using sputum culture and in vitro proportional drug sensitivity test.Results A total of 182 sputum samples were tested by sputum smear,sputum culture,and GeneXpert MTB/RIF,with the positive rates of 38.46%(70/182),55.49%(101/182),and 54.95%(100/182),respectively.Using sputum culture results as the gold standard,the sensitivity and specificity of GeneXpert MTB/RIF detection were 86.14%(87/101)and 87.65%(71/81),respectively.The consistency rate between GeneXpert MTB/RIF and sputum culture test results was 86.81%(158/182).Further analysis showed that the sensitivity and specificity of GeneXpert MTB/RIF for detecting Mycobacterium tuberculosis in smear positive patients were 91.80%(56/61)and 66.67%(6/9),respectively,while the sensitivity and specificity for detecting smear negative patients were 77.50%(31/40)and 90.28%(65/72),respectively.Using the in vitro proportional drug sensitivity test as the gold standard,the sensitivity of GeneXpert MTB/RIF in detecting rifampicin resistance in sputum culture positive patients was 83.33%(5/6),the specificity was 97.87%(92/94),and the consistency rate of the detection results was 97.00%(97/100).Conclusion GeneXpert MTB/RIF detection technology has a good application effect in the early diagnosis of tuberculosis and rifampicin resistance,and is suitable for large-scale promotion in grass-roots tuberculosis designated hospitals.