多色探针熔解曲线分析法评估结核分枝杆菌阳性患者对不同抗结核药物耐药性的诊断效能

Diagnostic Efficacy of Multicolor Melting Curve Analysis for Resistance to Different Antituberculosis Drugs among Mycobacterium Tuberculosis Positive Patients

目的:分析多色探针熔解曲线分析法(MMCA)评估结核分枝杆菌阳性患者对利福平、乙胺丁醇、链霉素、异烟肼、喹诺酮耐药性的诊断效能。方法:选取2023年1—6月泉州市各县(市)区结核定点医院收治的100例结核分枝杆菌阳性患者的痰培养标本,经过培养与分离获取100例结核分枝杆菌株,以改良罗氏比例法药敏试验为金标准,通过MMCA检测结核分枝杆菌对利福平、乙胺丁醇、链霉素、异烟肼、喹诺酮的耐药性,记录其符合率、敏感度、特异度、阳性预测值、阴性预测值。结果:MMCA检测利福平耐药性的符合率为94.00%,敏感度为83.33%,特异度为95.45%,阳性预测值为71.42%,阴性预测值为97.67%。MMCA检测乙胺丁醇耐药性的符合率为97.00%,敏感度为87.50%,特异度为97.83%,阳性预测值为77.78%,阴性预测值为98.90%。MMCA检测链霉素耐药性的符合率为98.00%,敏感度为85.71%,特异度为98.92%,阳性预测值为85.71%,阴性预测值为98.92%。MMCA检测异烟肼耐药性的符合率为90.00%,敏感度为76.47%,特异度为92.77%,阳性预测值为68.42%,阴性预测值为95.06%。MMCA检测喹诺酮耐药性的符合率为94.00%,敏感度为81.82%,特异度为95.51%,阳性预测值为69.23%,阴性预测值为97.70%。结论:MMCA评价结核分枝杆菌对利福平、乙胺丁醇、链霉素、异烟肼、喹诺酮的耐药性具有较好的特异度与敏感度,且便于检测,有助于对耐药结核杆菌的快速筛查。

Objective:To evaluate the diagnostic efficacy of Rifampicin,Ethambutol,Streptomycin,Isoniazid and Quinolone resistance in Mycobacterium tuberculosis positive patients by multicolor melting curve analysis(MMCA).Method:Sputum culture samples of 100 mycobacterium tuberculosis positive patients admitted to tuberculosis designated hospitals in Quanzhou from January to June 2023 were selected,and 100 mycobacterium tuberculosis strains were obtained through culture and isolation.The modified Roche ratio method drug susceptibility test was used as the gold standard.MMCA was used to detect the resistance of mycobacterium tuberculosis to Rifampicin,Ethambutol,Streptomycin,Isoniazid and Quinolone.The agreement rate,sensitivity,specificity,positive predictive value and negative predictive value were recorded.Result:The agreement rate,sensitivity,specificity,positive predictive value,and negative predictive value of MMCA detects Rifampicin resistance were 94.00%,83.33%,95.45%,71.42%and 97.67%respectively.The agreement rate,sensitivity,specificity,positive predictive value and negative predictive value of MMCA detects Ethambutol resistance were 97.00%,87.50%,97.83%,77.78%and 98.90%respectively.The agreement rate,sensitivity,specificity,positive predictive value and negative predictive value of MMCA detects Streptomycin resistance were 98.00%,85.71%,98.92%,85.71%and 98.92%respectively.The agreement rate,sensitivity,specificity,positive predictive value and negative predictive value of MMCA detects Isoniazid resistance were 90.00%,76.47%,92.77%,68.42%and 95.06%respectively.The agreement rate,sensitivity,specificity,positive predictive value and negative predictive value of MMCA detects Quinolone resistance were 94.00%,81.82%,95.51%,69.23%and 97.70%respectively.Conclusion:MMCA has good specificity and sensitivity to evaluate the resistance of mycobacterium tuberculosis to Rifampicin,Ethambutol,Streptomycin,Isoniazid and Quinolone,and is easy to detect,which is conducive to the rapid screening of drug resistance mycobacterium tuberculosis.