基因芯片技术在分枝杆菌菌种鉴定和结核耐药性检测中的应用及评价

摘要

目的：探讨基因芯片技术在结核病快速诊疗中的应用价值。方法对抗酸染色涂片阳性的肺结核患者痰标本同时进行基因芯片菌种鉴定和BACTEC MGIT 960培养，对结核阳性的样本分别用以上两种方法检测利福平和异烟肼的耐药性。以培养法为参考方法，评价基因芯片法菌种鉴定和耐药检测的敏感度、特异度和符合率。采用Kappa检验分析两种方法的一致性。结果656例涂片阳性的患者中，两种方法各检出非结核分枝杆菌21例，符合率为100％。耐药性检测发现，基因芯片对利福平的敏感度为87．8％（86／98），特异度为96．0％（410／427），符合率为94．5％（496／525），Kappa值为0．84，P＞0．05；对异烟肼的敏感度为81．9％（96／116），特异度为91．7％（375／409），符合率为89．5％（470／525），Kappa值为0．71，P＞0．05；两种药物药敏结果总符合率为92．0％（966／1050）。结论基因芯片技术能够准确地筛选出非结核分枝杆菌；对利福平和异烟肼耐药性检测与培养法有很好的符合率和高度一致性，而且能够快速、准确地检测结核分枝杆菌对利福平和异烟肼的耐药性，在结核病的快速诊疗领域具有广阔的应用前景。%Objective Study on the application value of rapid diagnosis and treatment of tuberculosis with Gene chip technology.Methods Mycobacterium species of sputum specimens of tuberculosis (positive acid fast stain)were identi-fied by Gene chip technology and were cultured by BACTEC MGIT 960.Detection of tuberculosis?positive samples re-sistance to rifampin and isoniazid using Gene chip technology and culture method with BACTEC MGIT 960.Culture method with BACTEC MGIT 960 was used as the reference method,Evaluation of the sensitivity,specificity,coinci-dence rate and the consistency of two methods of Gene chip technology in the identification of Mycobacterium species and drug resistance detection,Results 2 1 non-tuberculosis Mycobacterium were detected by the two methods in 6 5 6 patients with the smear-positive tuberculosis,the coincidence rate was 100%.The sensitivity was 87.8%(86/98),the specificity was96.0%(410/427),the coincidence rate was 94.5%(496/525),Kappa value 0.84 in the gene-chip detec-ting rifaman-resistance Mycobacterium tuberculosis.The sensitivity was 81.9%(96/116),the specificity was 91.7%(375/409),the coincidence rate was 89.5%(470/525),Kappa value 0.71 in the gene-chip detecting isoniazid-resistance Mycobacterium tuberculosis.Conclusion Gene chip technology is an effective method for accurate screening of non-tubercu-losis Mycobacterium.Gene chip technology and culture method with BACTEC MGIT 960 had a high coincidence rate and high consistence in the two methods detecting rifaman-resistance and isoniazid-resistance Mycobacterium tuberculosis.Gene chip technology has wide application prospect in diagnosis and treatment of tuberculosis patients,as it allows fast and accuracy de-tection of the resistance to Rifampin and Isoniazi in Mycobacterium tuberculosis clinical isolates.