肺結核痰涂陽標本直接檢測rpoB、katG及inhA耐藥基因的臨床意義

郭志平 陳曉紅 李學玲 翁麗珍 吳迪 黃明翔

[摘要] 目的 研究肺結核痰涂陽標本直接檢測ropB、katG及inhA耐藥基因的臨床價值。方法 方便選取福建省福州肺科醫院2017年1—10月收治的新發痰涂片陽性肺結核120例，利用基因芯片技術對涂陽痰標本和臨床分離菌株進行ropB、katG和inhA結核耐藥基因檢測，以BACTEC MGIT960培養法及藥敏試驗結果為對照，評估基因芯片技術檢測ropB、katG和inhA結核耐藥基因的臨床意義。 結果 對同時有兩種耐藥性檢測結果的108例涂陽痰標本進行統計學分析，以BACTEC MGIT960培養法及藥敏結果為對照，基因芯片技術檢測耐利福平結核分枝桿菌的ropB基因的符合率為97.2%，靈敏度為98.0%，特異度為87.3%，兩者比較差異無統計學意義（P>0.05）;基因芯片技術聯合檢測耐異煙肼結核分枝桿菌的katG和inhA基因的符合率為符合率為98.1%，靈敏度為88.9%，特異度為99.0%，兩者比較差異無統計學意義（P>0.05）。 結論 對于痰涂陽肺結核患者，利用基因芯片技術對痰涂陽標本直接檢測ropB、katG及inhA耐藥基因，能夠快速、準確地檢測結核分枝桿菌對利福平和異煙肼的耐藥情況，為早期診斷與治療提供科學指導。

[關鍵詞] 肺結核;基因芯片技術;利福平;異煙肼;耐藥性

[中圖分類號] R521? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-0742（2019）06（a）-0032-04

[Abstract] Objective To study the clinical value of direct detection of ropB， katG and inhA resistance genes in sputum smear positive specimens of pulmonary tuberculosis. Methods A total of 120 cases of new sputum smear positive tuberculosis admitted to Fuzhou Pulmonary Hospital from January to October 2017 were convenient selected. The drug resistance genes of ropB， katG and inhA tuberculosis were detected by gene chip technology in sputum smear positive specimens and clinical isolates. The drug resistance of ropB， katG and inhA tuberculosis was evaluated by using BACTEC MGIT960 culture method and drug sensitivity test as control. The clinical significance of genes. Results 108 smear-positive sputum specimens with two drug resistance test results were analyzed statistically. Compared with BACTEC MGIT960 culture method and drug sensitivity test， the coincidence rate， sensitivity and specificity of gene chip technology for detecting ropB gene of rifampicin-resistant Mycobacterium tuberculosis were 97.2%， 98.0% and 87.3%， respectively. There was no significant difference between the two methods （P>0.05）. The coincidence rate， sensitivity and specificity of combined detection of katG and inhA genes in isoniazid-resistant Mycobacterium tuberculosis were 98.1%， 88.9% and 99.0%， respectively， with no significant difference （P>0.05）. Conclusion For sputum smear positive pulmonary tuberculosis patients， using gene chip technology to directly detect ropB， katG and inhA resistance genes in sputum smear positive samples can quickly and accurately detect rifampicin and isoniazid resistance of Mycobacterium tuberculosis， and provide scientific guidance for early diagnosis and treatment.

[Key words] Tuberculosis; Gene chip technology; Rifampicin; isoniazid; Drug resistance