不同技术检测利福平耐药预测耐多药结核病的可靠性分析

Reliability analysis of rifampicin-resistance detected by different diagnostics as a predictor for multidrug-resistant tuberculosis

目的:分析不同技术检测利福平耐药(RR)预测耐多药(MDR)结核病的可靠性。方法:采用回顾性研究方法,从河南省胸科医院“医院信息管理系统”中搜集2021年7月至2022年11月收治的130例开展过MassARRAY核酸质谱技术检测结核分枝杆菌耐药性项目,并获得结核分枝杆菌核酸阳性结果及药物敏感性试验(简称“药敏试验”)数据的结核病患者实验室相关数据,追踪所有患者同期开展的GeneXpert MTB/RIF(简称“Xpert”)和表型药敏试验(pDST)检测结果进行对比分析。结果:在130例MassARRAY检测阳性的结核病患者中,37例(28.46%)报告为RR;102例Xpert检测阳性患者中,38例(37.25%)诊断为RR;48例培养阳性后行pDST的患者中,22例(45.83%)检出RR。在MassARRAY检出RR患者中,MassARRAY和pDST诊断的MDR占比分别为83.78%(31/37)和90.48%(19/21);在Xpert检出RR患者中,MassARRAY和pDST诊断的MDR占比分别为73.68%(28/38)和76.00%(19/25);在pDST检出RR患者中,MassARRAY和pDST诊断的MDR占比分别为90.91%(20/22)和95.23%(20/21);在MassARRAY和Xpert同时诊断RR患者中,MassARRAY和pDST诊断的MDR占比分别为88.89%(24/27)和88.89%(16/18);在MassARRAY或Xpert任一检出RR患者中,MassARRAY和pDST诊断的MDR占比分别为72.92%(35/48)和75.00%(21/28)。结论:不同方法检出RR作为预测MDR的标志具有良好的可靠性,但可靠程度与RR诊断技术的准确性相关。

Objective:To evaluate the reliability of rifampicin-resistance(RR)detected by different diagnostics as a predictor for multidrug-resistant tuberculosis(MDR-TB).Methods:A retrospective study was performed by searching the Hospital Information System of Henan Chest Hospital.A total of 130 TB patients who had performed MassARRAY assay for drug resistance detection from July 2021 to November 2022 were enrolled.Of these patients,their GeneXpert MTB/RIF assay(Xpert)and phenotypic drug susceptibility testing(pDST)results were collected for comparative analysis.Results:Among the 130 enrolled patients,37(28.46%)were reported as RR by MassARRAY,38(37.25%)of 102 patients with Xpert-positive result were categorized as RR patients,22(45.83%)of the 48 patients who underwent pDST after a positive culture were categorized as RR.Among patients with RR detected in MassARRAY,the proportion of MDR diagnosed by MassARRAY and pDST was 83.78%(31/37)and 90.48%(19/21),respectively.Among RR patients detected by Xpert,the proportion of MDR diagnosed by MassARRAY and pDST was 73.68%(28/38)and 76.00%(19/25),respectively.In patients with RR detected by pDST,the proportion of MDR diagnosed by MassARRAY and pDST was 90.91%(20/22)and 95.23%(20/21),respectively.Among RR patients diagnosed both by MassARRAY and Xpert,88.89%(24/27)and 88.89%(16/18)were diagnosed as MDR by MassARRAY or pDST,respectively.Among RR patients detected by any method of MassARRAY or Xpert,72.92%(35/48)and 75.00%(21/28)were reported as MDR by MassARRAY or pDST,respectively.Conclusion:The RR diagnosed by different diagnostics is a reliable indicator of MDR-TB,but the predictive reliability is related to the accuracy of RR diagnosis.