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目的评估Xpert MTB/RIF技术(简称Xpert法)快速筛查耐多药结核(MDR-TB)的可行性。方法采用Xpert法和结核液体药敏试验分别对197株痰培养检出结核分枝杆菌菌株做利福平耐药检测,比较两者诊断利福平耐药的一致性;收集温州市2 417例肺结核患者一线液体药敏试验结果,分析利福平耐药作为MDR-TB诊断指标的可行性;并依上述两项结果评估用Xpert法快速筛查耐多药结核的可能性。结果以液体药敏法为金标准,197株菌株中Xpert法检测利福平耐药的灵敏度为100.00%,特异度为98.45%,阳性预测值为97.14%,阴性预测值为100.00%,与液体药敏法检测结果具有较高的一致性(Kappa值=0.978)。对2 417例结核患者液体药敏结果进行分析,与同时对异烟肼和利福平耐药作为MDR-TB的诊断标准比较,利福平耐药作为MTB-TB筛查指标的灵敏度为100.00%,特异度为99.13%,阳性预测值为92.52%,阴性预测值为100.00%,两者Kappa值为0.957。结论 Xpert法可快速、准确检测利福平耐药性,至少在温州市可考虑将该法用于MDR-TB的快速筛查。
Objective To evaluate the feasibility of Xpert MTB / RIF technique (Xpert method) for rapid screening of multidrug-resistant tuberculosis (MDR-TB). Methods Xpert method and liquid drug susceptibility test were used to detect rifampicin resistance in 197 sputum cultures of Mycobacterium tuberculosis. The consistency of rifampicin resistance was evaluated. A total of 2 417 cases of Wenzhou Tuberculosis patients first-line liquid drug susceptibility test results, the analysis of the feasibility of rifampicin resistance as a diagnostic indicator of MDR-TB; and based on the two results to evaluate the possibility of rapid screening for multidrug-resistant tuberculosis by Xpert method. Results According to liquid drug susceptibility method, the sensitivity and specificity of Xpert method for detecting rifampicin resistance were 100.00%, 98.45%, 97.14% and 100.00% Drug sensitivity test results have a high consistency (Kappa value = 0.978). The susceptibility of 2 417 tuberculosis patients to liquid drug susceptibility was analyzed and compared with the diagnostic criteria of both isoniazid and rifampicin resistance as MDR-TB, the sensitivity of rifampicin as a screening index for MTB-TB was 100.00 %, The specificity was 99.13%, the positive predictive value was 92.52%, the negative predictive value was 100.00%, the Kappa value of both was 0.957. Conclusion Xpert method can rapidly and accurately detect rifampicin resistance, at least in Wenzhou City, the method can be considered for rapid screening of MDR-TB.