GeneXpert实时荧光定量PCR快速检测艰难梭菌的临床评估

摘要

目的：对GeneXpert实时荧光定量聚合酶链反应（PCR）在快速检测临床粪便标本中艰难梭菌的应用进行评估。方法采用双拭子蘸取临床未成形粪便标本，一支拭子用于GeneXpert实时荧光定量PCR检测艰难梭菌毒素基因tcdB，另一支用于常规厌氧菌培养检测；对GeneXpert实时荧光定量PCR检测结果与常规厌氧菌培养结果的一致性进行统计学分析，并计算GeneXpert实时荧光定量PCR的敏感性、特异性、阳性预测值和阴性预测值等参数。结果临床收集到141例未成形粪便标本，GeneXpert实时荧光定量PCR检出艰难梭菌毒素基因tcdB阳性42例，其中常规厌氧菌培养阳性34例，两者一致性较好（Kappa＝0．7750，P＜0．01），GeneXpert实时荧光定量PCR的敏感性、特异性、阳性预测值和阴性预测值分别为87．2％、92．2％、81．0％和94．9％。结论GeneXpert实时荧光定量PCR直接检测粪便标本中的艰难梭菌具有检测快速、操作简便等优点，有重要的临床应用价值。%Objective To evaluate the clinical application of GeneXpert real-time fluorescence quantitation polymerase chain reaction (PCR)in rapid detection of Clostridium difficile from stool.Methods Two-head swab was dipped in clinical stool specimens,one-head swab was used for GeneXpert real-time fluorescence quantitation PCR in detecting toxity gene tcdB ,and the other was used for anaerobic culture.The results of these 2 methods were compared and analyzed statistically,and the sensitivity,specificity,positive predictive value and negative predictive value of GeneXpert real-time fluorescence quantitation PCR were calculated.Results Totally 1 41 clinical stool specimens were collected,and GeneXpert real-time fluorescence quantitation PCR revealed that Clostridium difficile was positive in 42 cases,among which Clostridium difficile was cultured in 34 cases.GeneXpert real-time fluorescence quantitation PCR was well consistent with the culture method (Kappa=0.775 0,P<0.01 ),and the sensitivity,specificity,positive predictive value and negative predictive value of GeneXpert real-time fluorescence quantitation PCR were 87.2%, 92.2%,81 .0% and 94.9%,respectively.Conclusions GeneXpert real-time fluorescence quantitation PCR could detect Clostridium difficile from stool specimens directly and accurately,and it has a prospective potential for clinical application.