基因芯片快速檢測分枝桿菌技術輔助診斷小兒結核病的臨床研究

[摘要] 目的 探討基因芯片快速檢測分枝桿菌技術在輔助診斷小兒結核病方面的臨床研究。方法 方便選取2014年7月—2015年7月住于該院的經臨床、放射線疑診0～14歲肺結核77例為觀察對象，采用晶芯@結核病分子診斷系統對觀察對象痰標本進行檢測，將檢測結果與最終診斷相比較，并與羅氏痰培養結核菌法、痰涂片找結核菌、DNA檢測、PPD試驗、結核抗體、對INH＼RFP耐藥性及對非結核分枝桿菌菌種鑒定結果進行對比，分別計算各檢測方法的靈敏度和特異度，從而判斷基因芯片技術在診斷兒童結核病可行性、敏感、快速。結果 重癥結核感染17例，其中有9例（11.69%）為血行播散型肺結核，7例（9.09%）合并有結核性腦膜炎，1例（1.3%）合并骨結核。檢測異煙肼耐藥相關基因，基因芯片法和羅氏培養法比較χ2 =2.286，P=0.515，Kappa=0.604，檢測利福平耐藥相關基因，基因芯片法和羅氏培養法比較χ2 =58.77，P<0.05，Kappa=0.587。基因芯片法與羅氏培養法、PPD試驗、結核DNA、結核抗體、痰涂片多重比較，χ2 =64.91，P<0.05。 結果 基因芯片法可以快速檢測結核分枝桿菌，與羅氏培養法檢測結核分枝桿菌擁有中等一致性，其快速、無創，可以用于輔助診斷小兒結核病。

[關鍵詞] 小兒；結核病；基因芯片法

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2016）10（b）-0050-04

[Abstract] Objective To investigate the clinical study of rapid detection of Mycobacterium tuberculosis by gene chip in the diagnosis of pediatric tuberculosis. Methods Convenient selection clinical， X-ray suspected 0-14 years old pulmonary tuberculosis 70 cases in July 2014 to July 2015 live in our hospital as the observation object by Jingxin @ TB molecular diagnostic system of the observed object sputum specimens were detected， test results and final diagnosis was compared， in parallel with Roche sputum Mycobacterium tuberculosis， sputum smear， culture on the find tuberculosis bacteria， DNA testing， the PPD test， tuberculosis antibody， on drug resistance of INH＼RFP and of non tuberculosis mycobacterium species identification results were compared were calculated sensitivity and specificity of the detection method， in order to determine the gene chip technique in the diagnosis of childhood tuberculosis feasibility， sensitive， rapid. Results 17 cases of severe tuberculosis infection， including 9 cases （11.69%） were blood disseminated pulmonary tuberculosis， 7 cases （9.09%） with tuberculous meningitis， 1 cases （1.3%） with bone tuberculosis. Detection of isoniazid resistant related genes and gene chip method and Roche culture method χ2=2.286， P = 0.515， Kappa = 0.604， detection of rifampin resistance related gene， gene chip method and Roche culture method χ2=58.77， P < 0.05， Kappa =0.587. Gene chip and Roche culture method， PPD test， tuberculosis DNA， tuberculosis antibody， sputum smear multiple comparison. χ2=64.91， P < 0.05. Conclusion The gene chip method can quickly detect Mycobacterium tuberculosis， and the Roche culture method for detection of Mycobacterium tuberculosis with moderate consistency， its rapid， noninvasive， can be used for the diagnosis of tuberculosis in children.

[Key words] Children； Tuberculosis； Gene chip method

據2014年8月國家結核病預防控制中心與國際防癆與肺部疾病聯合會召開的會議，WHO人員預計我國兒童結核病的患者例數應占總人口患者例數的6%[1]。多個地區的調查結果也顯示兒童耐藥結核病發病率有所升高。然而由于兒童結核病痰涂片率及陽性率低，這些都給兒童結核病的診斷帶來更大困難。……