摘要
目的探讨Xpert MTB/RIF Ultra在快速检测结核分枝杆菌和利福平耐药中的应用价值。方法收集2019年12月至2020年5月就诊于福州肺科医院的447例疑似肺结核患者的痰标本,分别进行MGIT960液体培养及药敏、Xpert MTB/RIF(Xpert)和Xpert Ultra检测,将检出MTB的菌株和痰液进行rpoB基因Sanger测序。以临床诊断结果为参照,比较MGIT960液体培养、Xpert、Xpert Ultra检测MTB的敏感度和特异度;分别以液体药敏和测序结果为金标准,评价Xpert Ultra检测MTB利福平耐药性的效能。结果以临床确诊为参照,Xpert Ultra敏感度高于液体培养和Xpert,差异有统计学意义(χ^(2)=28.97、164.86,P均<0.05),特异度与液体培养和Xpert比较差异无统计学意义(P均>0.05)。分别以利福平液体药敏表型结果和rpoB基因测序结果为金标准,Xpert Ultra的敏感度为88.89%和93.75%。同时经测序分析,35例利福平耐药样本中,rpoB的531位点突变最为常见,占48.57%。结论Xpert Ultra能快速检测痰液中的MTB及其利福平耐药性,对肺结核早期诊疗有良好的临床应用价值,适合在各级实验室推广。
Objective To investigate the application value of Xpert MTB/RIF Ultra for rapid detection of Mycobacterium tuberculosis(TB)and its rifampicin resistance.Methods From December 2019 to May 2020,sputum specimens from 447 suspected TB patients attending Fuzhou Pulmonary Hospital were collected and tested for MGIT960 liquid culture and drug sensitivity.MGIT960 liquid culture and drug susceptibility,Xpert MTB/RIF(Xpert)and Xpert Ultra detection were carried out,and the strains and sputum with MTB detected were subjected to rpoB gene Sanger sequencing.The sensitivity and specificity of MGIT960 liquid culture,Xpert,and Xpert Ultra in detecting MTB were compared based on clinical diagnosis results;the effectiveness of Ultra in detecting rifampicin resistance in MTB was evaluated using liquid drug sensitivity and sequencing results as gold standards,respectively.Results Taking the clinical diagnosis result as a reference,the sensitivity of Xpert Ultra was higher than that of liquid culture and Xpert,and the difference was statistically significant(χ^(2)=28.97,164.86,P<0.05),but there was no significant difference in specificity between liquid culture and Xpert(P>0.05).The sensitivity of Xpert Ultra was 88.89%and 93.75%using rifampicin liquid phenotyping results and rpoB gene sequencing results as the gold standards,respectively.Furthermore,mutations at locus 531 in rpoB were the most common in 35 rifampicin⁃resistant samples by sequencing analysis,accounting for 48.57%.Conclusions Xpert Ultra can provide rapid detection of MTB and its rifampicin resistance in sputum,and has good clinical value for early diagnosis and treatment of pulmonary tuberculosis and is suitable for promotion in laboratories at all levels.
作者
王垚
林珍丽
陈新朝
黄明翔
WANG Yao;LIN Zhenli;CHEN Xinchao;HUANG Mingxiang(Department of Laboratory Medicine,Fuzhou Pulmonary Hospital&Fujian Medical University Clinical Teaching Hospital,Fuzhou,Fujian,China,350008)
出处
《分子诊断与治疗杂志》
2023年第5期871-875,共5页
Journal of Molecular Diagnostics and Therapy
基金
福建省卫生健康中青年骨干人才培养项目(2019GZQN⁃89)。
