骨关节结核不同类型标本进行Xpert MTB/RIF技术检测的研究

目的 比较利福平耐药荧光定量核酸扩增检测(Xpert MTB/RIF)技术在骨关节结核病灶不同类型标本检测中的差异。方法 选取骨关节结核患者245例，通过手术获取病灶中的脓液（199份）、干酪组织（161份）、肉芽组织（178份）、骨组织（87份），分别进行结核分枝杆菌培养、Xpert MTB/RIF检测，比较4种组织标本阳性率。计算2种检测方法的联合阳性率；以结核分枝杆菌培养和药物敏感试验作为金标准，计算Xpert MTB/RIF技术在骨关节结核标本及利福平耐药基因检测中的敏感度和特异度。结果 245例患者中结核分枝杆菌培养阳性112例(45.71%),625份标本中结核分枝杆菌培养阳性213份，结核分枝杆菌培养阳性率比较脓液＞干酪组织＞肉芽坏死组织＞骨组织(P＜0.01)。245例患者中Xpert MTB/RIF检测阳性128例(52.24%),625份标本中Xpert MTB/RIF检测阳性255份，Xpert MTB/RIF检测阳性率比较脓液＞干酪组织＞肉芽组织＞骨组织(P＜0.01)。2种方法联合检测阳性率为185例（75.51%）。Xpert MTB/RIF检测技术检验脓液、肉芽组织、干酪组织、骨组织阳性率均高于结核分枝杆菌培养(P＜0.05或P＜0.01)。Xpert MTB/RIF技术检测诊断骨关节结核的敏感度为96.43%，特异度为84.96%,诊断利福平耐药的敏感度为97.92%，特异度为93.75%。结论 为了准确诊断骨关节结核及利福平耐药性应尽量收集多种标本，特别是病灶中的脓液，Xpert MTB/RIF技术可简便、快速、准确地诊断结核分枝杆菌感染及其耐药性。

Study on Xpert MTB/RIF technology detection of different types of bone and j oint tuberculosis specimens

Objective To compare the difference of rifampicin fluorescence quantitative nucleic acid amplification detection(Xpert MTB/RIF) technology in the detection of different types of specimens of bone and joint tuberculosis lesions. Methods A total of 245 patients with bone and joint tuberculosis were selected, and the pus(199 parts), cheese tissue(161 parts), granulation tissue(178 parts), and bone tissue(87 parts) in the lesion were obtained by surgery, and were respectively cultured with Mycobacterium tuberculosis Xpert MTB/RIF detection. The positive rates of 4 kinds of tissue samples were compared. The sensitivity and specificity of xpert MTB/RIF in the detection of bone and joint tuberculosis and rifampicin resistance gene were calculated. Results Among 245 patients, 112(45.71%) were positive for Mycobacterium tuberculosis culture, 213(P＜0.01) were positive for Mycobacterium tuberculosis culture in 625 samples. Among 245 patients, 128(52.24%) were positive for Xpert MTB/RIF, and 255(255) were positive for Xpert MTB/RIF in 625 samples. The positive rate of xpert MTB/RIF was higher in pus than in cheese than in granulation than in bone(P＜0.01). The positive rate of the two methods was 185 cases(75.51%). The positive rates of pus, granulation, cheese and bone were higher than that of Mycobacterium tuberculosis(P＜0.05 or P＜0.01). The sensitivity and specificity of Xpert MTB/RIF were 96.43%, 84.96%, 97.92% and 93.75% respectively. Conclusion To accurately diagnose osteoarticular tuberculosis and rifampicin resistance, it is necessary to collect as many specimens as possible, especially the pus in the focus. Xpert MTB/RIF technology is simple, rapid and accurate for the diagnosis of Mycobacterium tuberculosis infection and drug resistance.