线性探针技术在海南省结核病诊断及耐药性检测中的应用

目的探讨线性探针技术在海南省结核病诊断及耐药性检测中临床应用。方法分别采用结核菌涂片、罗氏培养法、比例法药敏及线性探针技术对海南省疑似结核病患者痰液标本进行检测,并对检测结核分枝杆菌、耐药性及耐药突变特点进行分析。结果线性探针技术检测结核分枝杆菌阳性率(58.7%)明显高于结核菌涂片(40.2%)和罗氏培养(53.8%),线性探针法与两种传统方法比较差异有统计学意义(P<0.05);以比例法药敏为金标准,线性探针法对结核分枝杆菌耐利福平、异烟肼和耐多药结核分枝杆菌检测的特异性为89.27%、94.95%和91.45%,敏感性为94.38%、75.00%和75.68%,阴性预测值为94.62%、80.34%和5.60%,阳性预测值为85.71%、93.32%和84.85%,符合率为90.05%、85.34%和85.34%,线性探针技术与比例法药敏检测结核分枝杆菌利福平耐药性效果比较差异无统计学意义,且具有较好一致性,检测异烟肼耐药性差异有统计学意义,且两种方法之间一致性一般,检测耐多药结核分枝杆菌两种方法差异无统计学意义,但两种方法之间一致性一般;利福平耐药基因突变类型主要是 rpoB H531L,占57.14%,异烟肼耐药基因突变类型主要是katG S315T1,占91.89%,耐多药结核分枝杆菌耐药基因突变类型主要为rpoB S531L+KatG S315T1,占56.06%。结论线性探针技术可快速准确地从海南省疑似肺结核临床标本鉴定出结核分枝杆菌及耐多药结核分枝杆菌,并可直接快速检测临床标本耐药性从而指导临床用药。

Clinical application of linear probe technique in the diagnosis and drug resistance detection of tuberculosis in Hainan

Objective To explore the clinical application of linear probe technique in the diagnosis and drug resistance detection of tuberculosis in Hainan. Methods The sputum samples of suspected tuberculosis patients in Hainan were detected by tuberculosis smear, Roche culture method, proportional method drug sensitivity and linear probe technique, and the characteristics of detection of Mycobacterium tuberculosis, drug resistance and drug resistance mutation were analyzed. Results The positive rate of detection of Mycobacterium tuberculosis by linear probe technique was 58.7%, which was significantly higher than 40.2% of tuberculosis smear and 53.8% of Roche culture (all P<0.05). Taking the proportional method of drug sensitivity as the gold standard, the specificity of linear probe method for detection of rifampicin, isoniazid and multidrug-resistant M. tuberculosis were 89.27%, 94.95%, 91.45%, respectively; the sensitivity were 94.38%, 75.00%, 75.68%, respectively; the negative predictive values were 94.62%, 80.34%, 5.60%, respectively; the positive predictive values were 85.71%, 93.32%, 84.85%, respectively; the coincidence rates wre 90.05%, 85.34%, 85.34%. There was no statistical difference between the linear probe technique and proportional drug sensitivity test for the detection of rifampicin resistance in Mycobacterium tuberculosis; these two methods had statistically significant differences in the detection of isoniazid resistance, and the consistency between the two methods was general; these two methods had no statistical difference in the detection of multidrug-resistant M. tuberculosis, but the consistency between the two methods was general; The type of rifampicin resistance gene mutation was mainly rpoB H531L accounted for 57.14%; the type of isoniazid resistance gene mutation was mainly katG S315T1 accounting for 91.89%; the multidrug-resistant M. tuberculosis resistance gene mutation type was mainly rpoB S531L+KatG S315T1 accounted for 56.06. Conclusion Linear probe technology can quickly and accurately identify Mycobacterium tuberculosis and multidrug-resistant Mycobacterium tuberculosis from clinical specimens of suspected pulmonary tuberculosis in Hainan, which can be used directly to detect drug resistance in clinical specimens and guide clinical drug use.