肺结核痰涂阳标本直接检测rpoB、katG及inhA耐药基因的临床意义

郭志平 陈晓红 李学玲 翁丽珍 吴迪 黄明翔

[摘要] 目的 研究肺结核痰涂阳标本直接检测ropB、katG及inhA耐药基因的临床价值。方法 方便選取福建省福州肺科医院2017年1—10月收治的新发痰涂片阳性肺结核120例，利用基因芯片技术对涂阳痰标本和临床分离菌株进行ropB、katG和inhA结核耐药基因检测，以BACTEC MGIT960培养法及药敏试验结果为对照，评估基因芯片技术检测ropB、katG和inhA结核耐药基因的临床意义。 结果 对同时有两种耐药性检测结果的108例涂阳痰标本进行统计学分析，以BACTEC MGIT960培养法及药敏结果为对照，基因芯片技术检测耐利福平结核分枝杆菌的ropB基因的符合率为97.2%，灵敏度为98.0%，特异度为87.3%，两者比较差异无统计学意义（P>0.05）;基因芯片技术联合检测耐异烟肼结核分枝杆菌的katG和inhA基因的符合率为符合率为98.1%，灵敏度为88.9%，特异度为99.0%，两者比较差异无统计学意义（P>0.05）。 结论 对于痰涂阳肺结核患者，利用基因芯片技术对痰涂阳标本直接检测ropB、katG及inhA耐药基因，能够快速、准确地检测结核分枝杆菌对利福平和异烟肼的耐药情况，为早期诊断与治疗提供科学指导。

[关键词] 肺结核;基因芯片技术;利福平;异烟肼;耐药性

[中图分类号] R521          [文献标识码] A          [文章编号] 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