表型药物敏感性试验与GeneXpert MTB/RIF在耐药脊柱结核诊断中的作用

目的分析表型药物敏感性试验(简称"表型药敏试验")与GeneXpert MTB/RIF在耐药脊柱结核诊断中发挥的作用。方法回顾性分析2015-2018年首都医科大学附属北京胸科医院514例临床诊断为脊柱结核的患者资料,通过穿刺或外科手术获得病灶中的脓液、肉芽组织及干酪样坏死组织,并以无淀粉改良罗氏培养和浓度法进行结核分枝杆菌培养和表型药敏试验,同时进行GeneXpert MTB/RIF检测。结果 514例患者中,男260例(50. 6%),女254例(49. 4%);年龄1～86岁,平均(46. 2±18. 7)岁;腰椎结核200例(38. 9%),胸椎结核186例(36.2%),腰骶椎结核60例(11. 7%),胸腰段结核46例(8.9%),颈椎结核14例(2. 7%),颈胸段结核8例(1.6%)。109例培养阳性并获得表型药敏试验结果 ,阳性率为21. 2%;检出耐药患者25例(4. 9%,25/514),其中耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)患者9例,占阳性患者的8. 3%。GeneXpert MTB/RIF阳性383例(74.5%),其中发现rpoB突变47例(9. 1%, 47/514),包括表型药敏试验检出的9例MDR-TB和XDR-TB患者。结论脊柱结核病灶中耐药结核分枝杆菌通过表型药敏试验检出率偏低,不能及早发现耐药结核病患者,通过GeneXpert MTB/RIF方法可尽早发现更多耐药结核病患者。

The diagnosis value of phenotypic drug sensitivity test and GeneXpert MTB/RIF in drug-resistant spinal tuberculosis

Objective To analyze the role of phenotypic drug sensitivity test(DST) and GeneXpert MTB/RIF in the diagnosis of drug-resistant spinal tuberculosis. Methods Data of 514 patients diagnosed as spinal tuberculosis in Beijing Chest Hospital, Capital Medical University from 2015-2018 were retrospectively investigated. Pus, granulation tissue and caseous necrotic tissue in the focus were obtained by puncture and surgery in all the patients, then tubercle bacillus among them were cultured by modified L?wenstein-Jensen medium without potato starch and phenotypic drug sensitive tests by concentration methods were carried out, and GeneXpert MTB/RIF test was performed at the same time. Results In 514 patients, 260 were males (50.6%),254 were females (49.4%), ranging from 1 to 86 years old with an average age of 46.2±18.7 years. There were 200 (38.9%) cases of lumbar tuberculosis, 186 (36.2%) cases of thoracic tuberculosis, 60 (11.7%) cases of lumbosacral tuberculosis,46 (8.9%) cases of thoracolumbar tuberculosis,14 (2.7%) cases of cervical tuberculosis and 8 (1.6%) cases of cervical and thoracic tuberculosis. The results of drug sensitivity test were obtained in 109 cases, the positive ratio was 21.2%, 25 bacterial strains were resistance to one and more drugs, the positive ratio was 4.9%, 9 of the positive culture strains were multidrug-resistance tuberculosis and extensively-resistant tuberculosis (XDR-TB) (8.3%). Three hundred and eighty-three cases (74.5%) were positive for GeneXpert MTB/RIF, of which 47 cases (9.1%) were tested rpoB mutation including that of 9 MDR-TB patients confirmed by DST. Conclusion The detection rate of drug-resistant Mycobacterium tuberculosis in spinal tuberculosis focus is low through DST, and drug-resistant cases can not be detected early. GeneXpert MTB/RIF method has a high value for the early diagnosis of drug-resistant spinal tuberculosis patients.