结核分枝杆菌临床分离株利福平和异烟肼耐药性检测方法比较

Comparison of two methods detect of Mycobacterium tuberculosis clinical isolates resistance to rifampin and isoniazid

摘要:

目的  探讨基因芯片法和改良罗氏培养及比例法药敏试验在结核分枝杆菌（MTB）利福平（RFP）和异烟肼（INH）耐药性测定中的应用价值。方法  应用基因芯片法检测200株MTB临床分离株RFP耐药基因rpoB的6个位点、13种突变型，INH耐药基因katG的1个位点、2个突变型和INH inhA基因启动子-15位、1个C→T突变型。同时对MTB菌株进行罗氏培养及比例法药敏试验，并比较测定结果的敏感性、特异性和符合率。结果  基因芯片法检测敏感株152株、耐药株48株，罗氏比例法检测敏感株161株、耐药株39株。若以罗氏比例法测定结果为判断标准,基因芯片法检测RFP耐药性的敏感性、特异性和符合率分别为85.0%、98.8%和97.5%；检测INH耐药性的敏感性、特异性、符合率分别为82.8%、92.4%和91.0%。结论  基因芯片法对结核菌耐药菌株可做出初筛，与结核菌药敏试验联合检测可提高诊断率。

Abstract:

Objective To evaluate the use of gene chip, Lowenstein-Jensen (L-J) culture method and proportion method in detecting Mycobacterium tuberculosis (MTB) resistant of rifampinc (RFP) and isoniazid (INH). Methods A total of 200 MTB clinical isolates were chosed, 6 sites of resistant gene rpoB and 13 kinds of mutant of RFP were detected, and 1 site of resistant gene katG, 2 kinds of mutant and inhA gene promoter-15, 1 kind of C→T mutant of INH were detected. Meanwhile drug susceptibility of the 200 MTB clinical isolates with rapid culture and proportion method were detected. Then the sensitivity, specificity and accuracy were compared. Results A number of 152 sensitive isolates and 48 resistant isolates were detected by gene chip, and 161 sensitive isolates and 39 resistant were isolated by proportion method. If the result of proportion method was set as criteria, the sensitivity, specificity and accuracy of gene chip test RFP drug were 85%, 98.9% and 97.5%, for INH they were 82.8%, 92.4%, 91%. Conclusions Gene chip method can be used to preliminarily screen the drug-resisitant strains of Mycobacterium tuberculosis. Joint detection with proportion method can improve the diagnostic rate.