摘要
目的探讨多技术联合检测用于结核病及耐多药结核病快速诊断的临床价值。方法应用浓缩涂片法、结核分枝杆菌DNA荧光定量法(TB-DNA)和结核分枝杆菌RNA恒温扩增检测(SAT TB-RNA)组成的结核快速诊断技术(简称快速法)及线性探针结核分枝杆菌耐药快速检测系统(Hain Geno-Type MTBDRplus,简称HAIN)对1 180例结核病患者和1 120例非结核病对照者分别进行检测,同步进行BACTEC MGIT-960培养、鉴定及药敏试验,比较各方法的敏感性和特异性及结核病、耐多药结核病检出率。结果以BACTEC MGIT-960培养鉴定结果为金标准,快速法的敏感度为97.84%(543/555),特异度为96.16%(601/625),符合率为96.95%(1 144/1 180);2种方法的结核病检出率比较差异无统计学意义(χ2=0.245,P>0.05);以BACTEC MGIT-960药敏试验为金标准,HAIN检出耐多药结核病的敏感度为93.62%(44/47),特异度为99.41%(508/511),符合率为99.46%(552/555);2种方法的耐多药结核病检出率比较差异无统计学意义(χ2=0.102,P>0.05)。快速法结果报告时间缩短为1d,HA1N报告时间为2d。结论多技术联合检测对快速诊断结核病及耐多药结核病的敏感性和特异性都有明显的优势,显著缩短了检测时间,具有快速准确的诊断价值。
Objectives To determine the clinical value of combined techniques to rapidly diagnose tuberculosis and multidrug-resistant tuberculosis. Methods Rapid techniques to diagnose tuberculosis（denoted here as ＂rapid techniques＂）including concentrated smears,TB-DNA,SAT TB-RNA,and the Hain Geno-Type MTBDRplus were separately used to detect tuberculosis in 1 180 patients with tuberculosis and a control group of 1 120 patients without tuberculosis.The BACTEC MGIT-960 culture system was used for identification and a drug sensitivity test was performed.The sensitivity and specificity of the methods were compared and the rate of detection of tuberculosis and multi-drug-resistant tuberculosis was analyzed. Results Of the 1 180 specimens from patients with tuberculosis,567 were found to be positive for tuberculosis according to the rapid techniques,for a rate of detection of 48.05% while 555 were found to be positive for tuberculosis according to the BACTEC MGIT-960 culture system,for a rate of detection of 47.03%.Culturing and identification with the BACTEC MGIT-960 culture system served as the gold standard.The rapid techniques had a sensitivity of97.84%（543/555）and a specificity of 96.16%（601/625）,and the rate of diagnostic concordance was 96.95%（1 144/1 180）.There were no significant differences in the rate of detection with the rapid techniques and the BACTEC MGIT-960（χ2=0.245,P0.05）.Of the specimens from 1 120 patients without tuberculosis（the control group）,were found to be positive for tuberculosis according to the rapid techniques while 40 were found to be positive for tuberculosis according to the BACTEC MGIT-960 culture system（of these,25 were found to be positive for tuberculosis according to concentrated smears and 15 were found to be negative for tuberculosis according to concentrated smears）.Drug sensitivity testing with the BACTEC MGIT-960 culture system served as the gold standard.The Geno-Type MTBDRplus had a sensitivity of 93.62%（44/47）and a specificity of 99.41%（508/511）at detecting multi-drug-resistant tuberculosis,so the rate of concordance was 99.46%（552/555）.There were no significant differences in the rate of detection of multi-drug-resistant tuberculosis by the Geno-Type MTBDRplus and the BACTEC MGIT-960（2χ=0.102,P0.05）.The mean time to obtain results was reduced to 1day for the rapid techniques while the Geno-Type MTBDRplus took 2days,culturing with the BACTEC MGIT-960 took 9.5days,and drug sensitivity testing with the BACTEC MGIT-960 took 9days. Conclusion Combined techniques had the advantage of rapidly diagnosing tuberculosis and multi-drug-resistant tuberculosis with a high level of sensitivity and specificity.The combined techniques significantly reduced the testing time,so these techniques allowed accurate and rapid diagnosis of tuberculosis and multi-drug-resistant tuberculosis.
出处
《中国病原生物学杂志》
CSCD
北大核心
2015年第7期638-641,共4页
Journal of Pathogen Biology
基金
广东省汕头市科技重点攻关课题(No.2013072)
关键词
结核分枝杆菌
核酸扩增
线性探针
液体培养
诊断
耐药
Mycobacterium tuberculosis
nucleic acid amplification
linear probe
liquid culture
diagnosis
drug resistant
