关键词: 结核, 外科手术, 分子诊断技术, 实验室技术和方法, 对比研究, 结果评价(卫生保健)

Abstract:

Objective To preliminarily explore the value of molecular biological detection technology in the rapid diagnosis of postoperative tuberculosis patients.Methods We conducted a retrospective analysis of 170 patients with tuberculosis who underwent surgical treatment and had complete clinical data in the Shanghai Public Health Clinical Center from January 2015 to February 2018. Of the 170 patients, 100 (58.82%) were male and 70 (41.18%) were female; there were 18 cases (10.59%) in the 1 to 18 age group, 142 cases (83.53%) in the 19 to 65 age group, and 10 cases (5.88%) in the 66 to 82 age group. A total of 39 patients (22.94%) were pulmonary tuberculosis, and 131 patients (77.06%) had extrapulmonary tuberculosis. PCR membrane hybridization and second-generation sequencing techniques were applied for strain identification and drug resistance-related gene detection in postoperative specimens. All patients underwent acid-fast staining in sputum, needle biopsy before surgery, or intraoperative sampling, as well as Roche solid culture, BACTEC-MGIT 960 rapid culture, and drug susceptibility test in sputum.Results (1) The positive rate of acid-fast staining of sputum was 9.41% (16/170), and the positive rate of acid-fast staining of pulmonary tuberculosis sputum was 23.08% (9/39), while the positive rate of acid-fast staining was 51.76% (88/170) in the biopsy or intraoperative sampling. (2) The positive rate of mycobacterial culture was 27.65% (47/170); the positive rate of phenotypic susceptibility test was 14.12% (24/170). (3) The positive rate of postoperative molecular biology species identification was 51.76% (88/170). The result of PCR membrane Hybridization showed that 7 cases were identified as non-tuberculous mycobacteria; 4 cases were also identified as non-tuberculous mycobacteria by culture combined with MPB64 antigen detection, but 3 cases were not identified as non-tuberculous mycobacteria by culture method and could not be detected by MPB64 antigen detection. The seven specimens identified for strain identification by molecular biological detection were one case with co-infection of Mycobacterium phlei and Mycobacterium gordon, three cases of intracellular mycobacteria, one case of Mycobacterium marinum, one case of Mycobacterium avium, and one with Mycobacterium abscessus. (4) The drug sensitivity of the remaining 163 cases were detected by molecular biological method. The detection rate of first-line anti-tuberculosis drug resistance genes was 54.60% (89/163), while the rate was 49.69% (81/163) in the second-line anti-tuberculosis drugs. Compared with the results of drug sensitivity test after culture, 29.79% (14/47) of the samples with positive drug susceptibility test were negative in the detection of resistance gene by molecular biological technology. The consistency of molecular biological resistance gene detection and drug susceptibility test was 90.00% (27/30). The molecular biological and BACTEC-MGIT 960 rapid culture drug sensitivity test composite detection rate was 63.19% (103/163).Conclusion Molecular biological detection technology is of great value in the rapid diagnosis of postoperative specimens. It can distinguish between Mycobacterium tuberculosis and non-tuberculous mycobacteria and can identify whether the strain is drug resistant, which provides an important reference for further diagnosis and treatment of tuberculosis patients.

Key words: Tuberculosis, Surgical procedures, operative, Molecular diagnostic techniques, Laboratory techniques and procedures, Comparative study, Outcome assessment (health care)