分子生物学和液体培养方法提高综合医院结核病病原学诊断能力的价值

doi:10.3969/j.issn.1000-6621.2021.02.008

摘要/Abstract

摘要：

目的分析应用分子生物学检测及液体培养法对提升综合医院结核病病原学诊断能力的价值。方法提取中日友好医院病案系统中2014年3月至2018年12月全院各科室诊断为肺结核且上报传染病卡的1438例住院患者的诊断依据、病原学检测方法及结果、病原学送检时间及结果返回时间、入院时间及出院时间等信息。分析该院2014—2016年仅开展抗酸染色和分枝杆菌固体培养法(罗氏培养法)时与2017—2018年开展分子生物学检测[GeneXpert MTB/RIF检测(简称“GeneXpert检测”)]和液体培养法(BACTEC MGIT 960分枝杆菌快速液体培养)后肺结核患者病原学诊断能力和确诊时间的变化情况。结果 2014年该院肺结核患者病原学检测阳性率仅为19.83%(24/121),2018年升至53.89%(256/475)。分子生物学检测及液体培养法开展前后,肺结核患者病原学检测阳性率分别为22.68%(132/582)和49.65%(425/856),差异有统计学意义(χ²=106.184,P=0.000)。开展GeneXpert检测后(2017—2018年),该院经检测确诊的肺结核患者中利福平耐药比例为7.45%(28/376),而在开展前无耐药结核病诊断能力。开展分子生物学和液体培养法检测后(2017—2018年),肺结核患者确诊时间为7.00(3.00,12.00)d 明显短于开展之前(2014—2016年)的10.00(6.00,14.00)d,差异有统计学意义(Z=-7.815,P=0.000 )。结论分子生物学和液体培养方法的应用可提高综合医院结核病病原学诊断能力,缩短患者确诊时间。

关键词: 结核,肺, 早期诊断, 分子诊断技术, 医院,综合, 评价研究

Abstract:

Objective To analyze the value of applying molecular diagnosis and liquid culture methods in improving the diagnostic capabilities of tuberculosis in general hospitals. Methods Data of diagnostic basis, etiological test and the results, submitting time of specimen and result returning time, admission time and discharge time of 1438 inpatients diagnosed with pulmonary tuberculosis and reported with infectious disease cards in China-Japan Friendship Hospital from March 2014 to December 2018 in the medical record system were collected. The changes in the pathogenic diagnosis ability and time of diagnosis of tuberculosis were analyzed, between 2014-2016 when the hospital only carried out acid-fast staining and solid culture method of mycobacteria (Roche culture method), and 2017-2018 when the hospital carried out molecular diagnosis technique (GeneXpert MTB/RIF test) and liquid culture method (BACTEC MGIT 960 mycobacterium rapid liquid culture). Results The positive rate of pathogenic detection of pulmonary tuberculosis increased from 19.83% (24/121) in 2014 to 53.89% (256/475) in 2018. The difference of positive rate of pathogenic detection of pulmonary tuberculosis before and after the use of molecular diagnosis technique and liquid culture method was significant (22.68% (132/582) vs. 49.65% (425/856), χ²=106.184, P=0.000). After carrying out the GeneXpert MTB/RIF test (2017-2018), the rate of rifampin-resistant was found to be 7.45% (28/376), while drug resistant tuberculosis couldn’t be diagnosed before the use of the test. After carrying out molecular diagnosis technique and liquid culture method (2017-2018), the diagnosis time of tuberculosis was 7.00 (3.00, 12.00) d, which was significantly shorter than before (2014-2016)(10.00 (6.00, 14.00) d; Z=-7.815, P=0.000). Conclusion The application of molecular diagnosis technique and liquid culture method in general hospital can improve the diagnosis of tuberculosis and shorten the diagnosis time.

Key words: Tuberculosis,pulmonary, Early diagnosis, Molecular diagnostic techniques, Hospitals,general, Evaluation studies

崔晓敬, 魏栋, 王春雷, 曹彬. 分子生物学和液体培养方法提高综合医院结核病病原学诊断能力的价值[J]. 中国防痨杂志, 2021, 43(2): 143-146. doi: 10.3969/j.issn.1000-6621.2021.02.008

CUI Xiao-jing, WEI Dong, WANG Chun-lei, CAO Bin. Value of molecular diagnosis and liquid culture methods in improving the pathogenic diagnosis of pulmonary tuberculosis in general hospitals[J]. Chinese Journal of Antituberculosis, 2021, 43(2): 143-146. doi: 10.3969/j.issn.1000-6621.2021.02.008

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年份	肺结核患者 (例)	病原学阳性 [例(阳性率,%)]	涂阳 [例(阳性率,%)]	培阳 [例(阳性率,%)]	GeneXpert检测 [例(阳性率,%)]
2014年^a	121	24(19.83)	22(18.18)	3(2.48)	-
2015年	188	40(21.28)	40(21.28)	2(1.06)	-
2016年	273	68(24.91)	61(22.34)	3(1.10)	-
2017年	381	169(44.36)	92(24.15)	48(12.60)	139(36.48)
2018年	475	256(53.89)	96(20.21)	169(35.58)	237(49.89)
合计	1438	557(38.73)	311(21.63)	225(15.65)	386(26.84)