CAJ | 학술논문

目的运用GenoType MTBDRplus线性探针法鉴定结核分枝杆菌耐药情况,与传统药物敏感试验进行比较,评估其在预测耐药结核患者预后中的作用.方法收集浙江省诸暨市人民医院2011年2月到2012年1月基线痰涂片阳性的肺结核患者标本275份,进行结核分枝杆菌的分离培养及药物敏感试验.同时采用GenoType MTBDRplus线性探针法检测异烟肼及利福平耐药情况.对所有入组结核患者进行随访,包括痰培养和胸部X线片.结果 GenoType MTBDRplus线性探针法和传统药物敏感试验均为耐药者有192株.传统药物敏感试验发现14株耐多药菌株,21株异烟肼单耐药株和2株利福平单耐药株,而GenoType MTBDRplus线性探针法分析结果分别为14、18和2株.以传统药物敏感试验作为金标准,线性探针分析利福平耐药性一致；21株耐异烟肼株中,5株未检测出.GenoType MTBDRplus线性探针法检测耐药的患者中,131株敏感菌治疗成功10例,占84.0％；15株异烟肼单耐药、11株多重耐药株中,治疗成功分别有9例和3例.2例单耐利福平,其中1例治愈,1例失败.分子耐药检测对异烟肼单耐药患者治疗失败的预测值为40.0％；对异烟肼敏感患者治疗成功的预测值为83.5％；对利福平单耐药患者治疗失败的预测值为50.0％,对利福平敏感患者治疗成功的预测值为81.5％；对耐多药结核患者治疗失败的预测值为72.7％,对非耐多药患者治疗成功的预测值为81.1％.结论 GenoType MTBDRplus线性探针法是检测结核分枝杆菌耐药性的一项快速、可靠的方法,其耐药检测结果可用于临床耐药结核预后的预测.
목적 운용GenoType MTBDRplus선성탐침법감정결핵분지간균내약정황,여전통약물민감시험진행비교,평고기재예측내약결핵환자예후중적작용.방법 수집절강성제기시인민의원2011년2월도2012년1월기선담도편양성적폐결핵환자표본275빈,진행결핵분지간균적분리배양급약물민감시험.동시채용GenoType MTBDRplus선성탐침법검측이연정급리복평내약정황.대소유입조결핵환자진행수방,포괄담배양화흉부X선편.결과 GenoType MTBDRplus선성탐침법화전통약물민감시험균위내약자유192주.전통약물민감시험발현14주내다약균주,21주이연정단내약주화2주리복평단내약주,이GenoType MTBDRplus선성탐침법분석결과분별위14、18화2주.이전통약물민감시험작위금표준,선성탐침분석리복평내약성일치；21주내이연정주중,5주미검측출.GenoType MTBDRplus선성탐침법검측내약적환자중,131주민감균치료성공10례,점84.0％；15주이연정단내약、11주다중내약주중,치료성공분별유9례화3례.2례단내리복평,기중1례치유,1례실패.분자내약검측대이연정단내약환자치료실패적예측치위40.0％；대이연정민감환자치료성공적예측치위83.5％；대리복평단내약환자치료실패적예측치위50.0％,대리복평민감환자치료성공적예측치위81.5％；대내다약결핵환자치료실패적예측치위72.7％,대비내다약환자치료성공적예측치위81.1％.결론 GenoType MTBDRplus선성탐침법시검측결핵분지간균내약성적일항쾌속、가고적방법,기내약검측결과가용우림상내약결핵예후적예측.
Objective To identify drug resistance status of Mycobacterium tuberculosis (MTB) strains by the GenoType MTBDRplus line-probe assay (LPA),compare its performance with traditional drug susceptibility testing (DST),and to assess its predictive value for the prognosis of patients with drug resistance tuberculosis.Methods Pulmonary tuberculosis patients who visited Zhuji People's Hospital,Zhejiang Province during February 2011 and January 2012 with a positive result of sputum smear at baseline were all recruited.A total of 275 culture positive specimens were collected,then isolated and cultured for Mycobacterium tuberculosis in the laboratory.DST were performed,meanwhile,GenoType MTBDRplus were also applied to detect resistance to isoniazid (INH) and rifampin (RMP).All the tuberculosis patients who were recruited were followed,including sputum culture and chest radiography.Results There were 192 strains showing drug resistance both by DST and MTBDRplus LPA.Fourteen multidrug resistant (MDR),21 INH mono-resistant and 2 RMP mono-resistant strains were detected by DST.As for GenoType MTBDRplus LPA,MDR,INH mono-resistant and RMP mono-resistant strains were 14,18 and 2,respectively.Taken DST as the gold standard,LPA was more accurate in the detection of resistance to RMP,while it failed to detect 23.8％ (5/21) of the INH-resistant strains.We analyzed the prognosis of patients with drug resistance by GenoType MTBDRplus LPA,the rates of treatment success were 84 ％ (110/131),9/15,3/11 in patients infected with susceptible,INH mono-resistant and MDR strains,respectively.For the 2 cases of RMP mono-resistanee,one was cured and the other failed.The predictive value of molecular drug resistance test for treatment failure in INH mono-resistant patients was 40.0 ％,while that was 83.5 ％ for treatment success in INH susceptible patients.The predictive value for treatment failure in RMP mono-resistant patients was 50.0％,while that was 81.5％ for treatment success in RMP susceptible patients.The predictive value for treatment failure in MDR patients was 72.7％,while that was 81.1％ for treatment success in patients without MDR.Conclusion The GenoType MTBDRplus LPA assay is a rapid and reliable diagnostic test for resistance of MTB,which can be used to predict the prognosis of drug resistant tuberculosis in the clinical practice.