摘要
目的评价利福平耐药实时荧光定量核酸扩增检测技术（GeneXpert MTB／RIF，简称“Xpert技术”）快速诊断骨关节结核及其耐药性的临床应用价值。方法2015年11月至2016年10月连续收集首都医科大学附属北京胸科医院的272例疑似骨关节结核患者的病灶标本，每份标本行涂片抗酸杆菌检查、BACTECMGIT960分枝杆菌培养、罗氏培养和Xpert技术检测；罗氏培养阳性的结核分枝杆菌行绝对浓度法药物敏感性试验（DST）检测。以临床诊断参考标准（CRS）为金标准，评价涂片抗酸杆菌检查、BACTECMGIT960分枝杆菌培养、罗氏培养和Xpert技术检测骨关节结核病灶标本中结核分枝杆菌感染的敏感度和特异度。以DST为金标准，评价Xpert技术检测病灶标本中结核分枝杆菌利福平耐药性的敏感度和特异度。结果以CRS为金标准，涂片抗酸杆菌检查、BACTECMGIT960分枝杆菌培养、罗氏培养和Xpert技术检测的敏感度分别为23．90％（60／251）、47．81％（120／251）、25．50％（64／251）和78．09％（196／251）；21例非骨关节结核患者标本中4种技术检测结果均为阴性。以DST为金标准，17例对利福平耐药的标本中，Xpert技术检测利福平耐药全部阳性。结论Xpert技术检测骨关节结核标本中结核分枝杆菌的敏感度和特异度高，并且可同时检测结核分枝杆菌对利福平是否耐药，值得推荐用于临床早期诊断骨关节结核。
Objective To evaluate the performance of a real-time polymerase-chain reaction （PCR） assay, Xpert MTB/RIF （Xpert）, for the rapid diagnosis of bone and joint tuberculosis （BJTB） and the detection of rifampin （RFP） resistance. Methods The specimens were obtained from 272 patients who were suspected to be BJTB when they visited the Beijing Chest Hospital between November 2015 and October 2016. Smear, BACTEC MGIT 960 culture, L6wenstein-Jensen＇s solid culture and Xpert were performed for each specimen, and L-J culture based drug susceptibility testing （DST） was conducted for all the recovered isolates. The sensitivity and specificity of Xpert in detecting Mycobacterium tuberculosis were assessed in comparison to a composite reference standard （CRS）. The sensitivity and specificity of Xpert for detection of RFP resistance was assessed in comparison to the DST results. Results The sensitivities of Smear, BACTEC MGIT 960, culture and Xpert were 23. 90% （60/251）, 47.81% （120/251）, 25.50% （64/251） and 78.09% （196/251） respectively. The results of these 4 techniques were negative in 21 non-tuberculosis patients. Seventeen RFP-resistant isolates were identified by culture based DST. Xpert was 100% concordant with MGIT based DST for the detection of RFP resistance. Conclusion With high sensitivity and specificity, and its ability to detect drug resistance simultaneously in less than 2 h, Xpert is feasible and valuable to be recommended as a quick diagnostic tool for BJTB in clinical practice.
出处
《中国防痨杂志》
CAS
2017年第4期337-341,共5页
Chinese Journal of Antituberculosis
基金
北京市科技计划课题（D141107005214002）
关键词
结核
骨关节
核酸扩增技术
诊断技术和方法
抗药性
评价研究
Tuberculosis, osteoarticular
Nucleic acid amplification techniques
Diagnostic techniques and methods
Drug resistance
Evaluation study
