MGIT 960系统行二线抗结核药物敏感性试验的实用性评价

目的 评价全自动BACTEC MGIT 960系统在结核分枝杆菌二线抗结核药物（second-line anti-TB drugs，SLD）药敏试验中的实用性。 方法 本实验纳入患者435例。该纳入患者均通过痰涂片抗酸染色（萋-尼法）镜检，L-J固体和MGIT 960系统液体培养及鉴定，共筛查出阳性菌株212例。212例阳性菌株分别进行一线抗结核药物异烟肼（INH）、利福平（RFP）、链霉素（S）和乙胺丁醇（EMB）的耐药性试验，其中耐药菌株（所有耐药株）118例。以118例耐药株作为SLD药敏试验实验株，应用L-J和MGIT 960两种方法分别进行卷曲霉素（Cm）、卡那霉素（Km）、氧氟沙星（Ofx）和乙硫异烟胺（Eto）的药物敏感性试验，并计算出两方法药敏试验所需的时间和符合率；L-J和MGIT960两种培养方法的比较采用配对设计的卡方检验；两种方法检测结果的一致性用Kappa值检验判别。 结果 MGIT 960系统药敏试验所需时间平均10.0 d（1183/118），L-J固体培养法所需时间平均28.5 d（3360/118），两者相差18.5 d。MGIT 960与L-J培养法的SLD Cm、Km、Ofx和Eto敏感及耐药符合率和一致性检验Kappa值分别为88.1%（104/118）和0.520；95.8%（113/118）和0.815；91.5%（108/118）和0.824；71.2%（84/118）和0.375。 结论 MGIT 960系统液体培养法常用SLD药敏试验与金标准（L-J培养）比较除Eto外符合率高、一致性好；该方法检测快速、准确，具有很强的实用性，可作为结核分枝杆菌快速培养和药敏试验的新方法。

The practical evaluation of second-line anti-tuberculosis drug susceptibility test using MGIT 960 system

Objective To evaluate the practicality of automatic BACTEC MGIT960 system in second-line anti-tuberculosis(TB) drug susceptibility test.Methods 212 M.tuberculosis strains were isolated and idenfied from the sputum specimen in 435 cases by the smear,Lowenstein-Jenson(L-J) solid culture and MGIT960 liquid culture and identification.These strains were determined the resistance to first-line anti-TB drugs including isoniazid(INH),rifampicin(RFP),streptomycin(S) and ethambutol(EMB) by L-J proportion method,respectively.Then the first-line anti-TB drug-resistant strains were further determined the resistance to second-line anti-TB drugs including capreomycin(Cm),kanamycin(Km),ofloxacin(Ofx) and ethionamide(Eto) by L-J and MGIT960,respectively.The detection time and accordance rate of the two methods were compared.Results The times of drug susceptibility test by MGIT960 and L-J method were average 10.0 days(1183/118) and 28.5 days(3360/118),respectively.There was difference of 18.5 days(28.5-10.0) between two methods.The accordance rates of MGIT960 and L-J method in Cm,Km,Ofx and Eto susceptibility test were 88.1%(104/118),95.8%(113/118),91.5%(108/118) and 71.2%(84/118).Conclusion The second-line anti-TB drug susceptibility test using MGIT960 system is fast,accurate and has higher practical value.