耐药基因检测在初次复治肺结核患者中的应用价值

目的 研究耐药基因检测在初次复治肺结核中的临床价值.方法 选取河北省胸科医院2014年1月-2015年12月收治的初次复治时痰液或支气管肺泡灌洗液浓缩集菌抗酸染色阳性的肺结核患者128例,采用BACTEC MGIT 960培养基对痰标本进行培养,同时分别选取高浓度和低浓度异烟肼(INH)和利福平(RFP)进行药敏试验,并采用基因芯片法对药敏阳性菌株进行耐药基因突变检测,分析药敏阳性菌株的耐药基因突变率.结果 128例初次复治肺结核患者中,对RFP的耐药率为25.00％,对INH的耐药率为22.66％.基因芯片检测耐RFP结核分枝杆菌的rpoB基因的符合率为96.23％、特异性为97.46％、敏感度为91.67％;基因芯片检测耐INH结核分枝杆菌的katG基因的符合率为94.89％、特异性为98.14％、敏感度为81.94％.结论 对初次复治肺结核患者耐药基因的检测,可快速、准确的检测出结核分枝杆菌耐药基因,准确推断耐药种类,为临床早期诊断及治疗提供科学指导.

Value of Drug Resistance Gene Detection in Primary Retreatment of Patients with Pulmonary Tuberculosis

Objective To study clinical value of drug resistance gene detection in primary retreatment of patients with pulmonary tuberculosis.Methods A total of 128 primary retreatment patients with pulmonary tuberculosis admitted between January 2014 to December 2015 were selected,whose sputum or concentrated bacterium acid-fast staining for bronchoalveolar lavage fluid were positive.Sputum samples were cultured with BACTEC MGIT 960 medium,and high and low concentrations of Isoniazid (INH) and Rifampicin (RFP) were selected simultaneously for drug sensitivity test.Gene chip method was used to detect the drug resistance gene mutation of positive drug resistant strains,and mutation rate of positive drug resistance gene was analyzed.Results Among the 128 patients,RFP drug resistance rate was 25.00％,and INH drug resistance rate was 22.66％.Gene chip method showed that the coincidence rate of rpoB gene for RFP resistance mycobacterium tuberculosis was 96.23％;the specificity was 97.46％;the sensitivity was 91.67％.Gene chip method showed that the coincidence rate of katG gene for NH resistance mycobacterium tuberculosis was 94.89％;the specificity was 98.14％;the sensitivity was 81.94％.Conclusion Detection of drug resistance genes for primary retreatment patients with pulmonary tuberculosis can quickly and accurately detect mycobacterium tuberculosis resistance genes,accurately judge types of drug resistance,and therefore it can provide scientific guidance for early diagnosis and treatment.