痰噬菌体生物扩增法检测一线抗结核药物敏感性的临床应用研究

目的 观察噬菌体生物扩增(phab)法测定痰样本结核分枝杆菌的药物敏感性在临床应用的效果.方法 应用phab法检测143例涂阳肺结核患者痰样本中的结核分枝杆菌对一线抗结核药物的敏感性,并根据检测结果及时调整化疗方案,随访这些患者的痰菌转阴情况和临床疗效,与同期住院未行phab法检测的菌阳肺结核患者进行回顾性地对比.均数的比较采用成组t检验；计数指标采用卡方检验进行对比,其中若出现值为0时采用四格表精确检验法.结果 143例涂阳肺结核患者phab法检测的阳性率为94.4％( 135/143),三类患者的阳性率比较差异无统计学意义(x2=1.886,p＞0.05).phab组患者痰送检至获得药敏检测结果的时间为(6.6±1.8)d,对照组为(29.4±8.7)d,差异有统计学意义(t=29.01,p＜0.01).Ⅱ类肺结核患者中,phab组的2个月转阴率(63.2％ vs.35.1％,x2 =3.989,p＜0.05)和总治愈率较对照组高(100％ vs.78.4％,p＜0.05).Ⅰ类和Ⅲ类肺结核患者的phab组和对照组在转阴率和治愈率方面比较无明显差异.结论 phab法检测痰样本中的结核分枝杆菌药敏结果对涂阳肺结核的方案制订具有较好的指导意义.abstract：objective to evaluate clinical application of phage amplified biologically assay (phab) in susceptibility test of mycobacterium tuberculosis (mtb) in sputum. methods the drug susceptibility of mtb was detected by phab in 143 patients with sputum-positive pulmonary tuberculosis (ptb),and the chemotherapy regimens were adjusted according to the results of susceptibility test.independent samples t-tests were used for comparison of means.count numbers were compared with chisquare test.if there were count number of 0,fisher probabilities should be used.results the total positive rate of phab was 94.4％ (135/143) with no differences between three types of ptb (x2 =1.886,p ＞ 0.05 ).the duration of testing for phab group was (6.6 ± 1.8) days,while for control was (29.4 ±8.7) days (t =29.01,p ＜ 0.01 ).compared with control group,the 2-month negative-conversion rate (63.2％ vs.35.1％,x2 =3.989,p ＜ 0.05 ) and cure rate ( 100％ vs.78.4％,p ＜ 0.05 ) of phab group in type Ⅱ patients were significantly higher.but there were no differences between phab and control groups in type Ⅰ and Ⅲ ptb patients.conclusion the results of phab drug susceptibility test can be helpful for choosing effective chemotherapy regimen for ptb patients rapidly.

clinical application of first line anti-tuberculous drug susceptibility test by phage amplified biologically assay