The effect of GeneXpert MTB/RIF detection technology in tuberculosis prevention and control program in Xinjiang

doi:10.19982/j.issn.1000-6621.20230321

Abstract

Abstract: Objective: To explore the effect of using GeneXpert MTB/RIF (“GeneXpert” for short) to detect pulmonary tuberculosis and rifampicin resistant pulmonary tuberculosis in the implementation of the “Xinjiang model” of tuberculosis prevention and treatment. Methods: The registration data of pulmonary tuberculosis in Xinjiang Uygur Autonomous Region (“Xinjiang” for short) from 2017 to 2020 were collected from the “Tuberculosis Management Information System”, a subsystem of the “China Disease Prevention and Control Information System”, and the effect of the comprehensive application of GeneXpert detection was analyzed. The etiologically positive rate, rifampicin resistance detection rate, rifampicin resistance cases detected from 2017 to 2020 were evaluated. Results: The coverage rate, detection rate of GeneXpert devices, and overall etiologically positivity rate of all patients increased from 20.00% (22/110), 0.32% (126/39261), and 20.17% (7919/39261) in 2017 to 100.00% (110/110), 75.16% (19610/26090), and 57.94% (15116/26090) in 2020, respectively, and the differences were statistically significant (χ²=40.705, P<0.001; χ²=174.087, P<0.001; χ²=47.569, P<0.001). The number of etiologically positive patients increased from 7919 in 2017 to 15116 in 2020, and the number of GeneXpert positive patients alone increased from 6 in 2017 to 7194 in 2020, accounting for an proportion from 0.08% (6/7919) to 47.59% (7194/15116), with a statistically significant difference (χ²=83.824, P<0.001). The screening rate of rifampicin resistance and the resistance screening rate with GeneXpert in etiologically positive pulmonary tuberculosis patients increased from 44.49% (3523/7919) and 1.85% (65/3523) in 2017 to 99.79% (15084/15116) and 96.13% (14501/15084) in 2020, respectively, and the differences were statistically significant (χ²=133.333, P<0.001; χ²=250.893, P<0.001). Conclusion: The application of GeneXpert detection technology can significantly improve the detection level of etiologically positive and rifampicin resistant pulmonary tuberculosis cases, help the rapid decline of local tuberculosis epidemic in Xinjiang.

Key words: Tuberculosis, pulmonary, Rifampin, Drug resistance, Nucleic acid amplification techniques, Comparative study

CLC Number:

R521

Gulina Badeerhan, Liu Nianqiang, Yipaer Aihaiti, Wang Le, Wang Senlu, Zulikatiayi Abudula, Wang Mingzhe, Zhang Jing, Wang Xinqi, Bi Hongbo. The effect of GeneXpert MTB/RIF detection technology in tuberculosis prevention and control program in Xinjiang[J]. Chinese Journal of Antituberculosis, 2024, 46(2): 173-177. doi: 10.19982/j.issn.1000-6621.20230321

Figures/Tables 4

References 12

[1]	王前, 李涛, 杜昕, 等. 2015—2019年全国肺结核报告发病情况分析. 中国防痨杂志, 2021, 43(2):107-112. doi:10.3969/j.issn.1000-6621.2021.02.002.
[2]	Su W, Ruan YZ, Li T, et al. Characteristics of rifampicin-resistant tuberculosis detection in China, 2015—2019. Infect Dis Poverty, 2021, 10(1): 99. doi:10.1186/s40249-021-00883-8.
[3]	World Health Organization.Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
[4]	田甜, 李月华, 顾晓明, 等. 2010—2011年新疆维吾尔自治区公众结核病防治知识知晓率调查分析. 中国防痨杂志, 2015, 37(9):953-959. doi:10.3969/j.issn.1000-6621.2015.05.008.
[5]	中华人民共和国国务院办公厅. 国务院办公厅关于印发 “十三五”全国结核病防治规划的通知. 国办发〔2017〕16号. 2017-02-01.
[6]	王新旗, 依帕尔·艾海提, 王森路, 等. 新疆结核病防治模式初探及展望. 疾病预防控制通报, 2022, 37(2):11-16. doi:10.13215/j.cnki.jbyfkztb.2112021.
[7]	中华人民共和国国家卫生和计划生育委员会.WS 288—2017肺结核诊断. 2017-11-09.
[8]	周林, 刘二勇, 孟庆琳, 等. 《WS 288—2017 肺结核诊断》标准实施后肺结核诊断质量评估分析. 中国防痨杂志, 2020, 42(9): 910-915. doi:10.3969/j.issn.1000-6621.2020.09.005.
[9]	中华人民共和国国家卫生健康委员会, 中华人民共和国国家发展改革委员会, 中华人民共和国教育部, 等. 关于印发遏制结核病行动计划(2019—2022年)的通知. 国卫疾控发〔2019〕41号. 2019-05-31.
[10]	周银发, 李燕平, 魏淑贞, 等. GeneXpert MTB/RIF对涂阴疑似肺结核及利福平耐药性检测的价值. 结核病与肺部健康杂志, 2019, 8(2):133-137. doi:10.3969/j.issn.2095-3755.2019.02.012.
[11]	World Health Organization. WHO operational handbook on tuberculosis. Module 3: diagnosis rapid diagnostics for tuberculosis detection. Geneva: World Health Organization, 2020.
[12]	中国防痨协会. 利福平耐药肺结核诊断流程. 北京: 中国防痨协会, 2021.

年份	肺结核患者例数	GeneXpert检测		病原学阳性
年份	肺结核患者例数	例数	检测率(%)	例数	阳性率(%)
2017	39261	126	0.32	7919	20.17
2018	72037	4687	6.51	14406	20.00
2019	42288	21780	51.50	19614	46.38
2020	26090	19610	75.16	15116	57.94

年份	涂片阳性	涂阴培阳	仅GeneXpert阳性	合计
2017	7527(95.05)	386(4.87)	6(0.08)	7919(100.00)
2018	11591(80.46)	1642(11.40)	1173(8.14)	14406(100.00)
2019	9977(50.87)	4042(20.61)	5595(28.52)	19614(100.00)
2020	5758(38.09)	2164(14.32)	7194(47.59)	15116(100.00)

年份	病原学阳性例数	耐药筛查例数	耐药筛查率 (%)	检测方法[例(构成比,%)]
年份	病原学阳性例数	耐药筛查例数	耐药筛查率 (%)	传统药物敏感性试验	GeneXpert检测
2017	7919	3523	44.49	3458(98.15)	65(1.85)
2018	14406	8638	59.96	5626(65.13)	3012(34.87)
2019	19614	19559	99.72	1745(8.92)	17814(91.08)
2020	15116	15084	99.79	583(3.87)	14501(96.13)

年份	涂阳肺结核患者		涂阴肺结核患者		合计 (例)
年份	利福平耐药例数	利福平耐药率(%)	利福平耐药例数	利福平耐药率(%)	合计 (例)
2017	231	91.67	21	8.33	252
2018	374	90.12	41	9.88	415
2019	389	63.05	228	36.95	617
2020	196	57.82	143	42.18	339

[1]	Pei Shaojun, Ou Xichao. Interpretation of the World Health Organization’s Catalogue of mutations in Mycobacterium tuberculosis complex and their association with drug resistance (2nd Edition) [J]. Chinese Journal of Antituberculosis, 2024, 46(3): 260-266.
[2]	Li Ting, Liu Shuang, Wang Danxia, Lu Jia, Cheng Qianqian, Chen Chuang, He Jin’ge, Zhang Linglin, Xia Yong, Li Jing, Zhang Shu, Gao Wenfeng, Xia Lan. Evaluation of health economics of implementation of tuberculosis prevention and control program in Sichuan Province from 2011 to 2020 [J]. Chinese Journal of Antituberculosis, 2024, 46(3): 333-339.
[3]	Fu Liang, Deng Guofang. MDR-Chin study analysis: prospects of using all-oral short-course treatment regimens for multidrug-resistant pulmonary tuberculosis in China [J]. Chinese Journal of Antituberculosis, 2024, 46(1): 18-22.
[4]	Liu Mei, Wu Xia, Gu Xu, Li Nana, Zhang Wanmin, Zhang Xiaoke, Lan Yuanbo. Evaluation of the performance of InnowaveDX MTB/RIF in detecting Mycobacterium tuberculosis complex and rifampicin resistance [J]. Chinese Journal of Antituberculosis, 2024, 46(1): 70-74.
[5]	Ding Qin, Zhang Shengkang, Ren Fei, Chen Xiaohong, Hu Chunmei, Chen Wei, Fan Lin. Nutritional status of drug-resistant pulmonary tuberculosis patients and the influencing factors: a multi-center, large-sample study [J]. Chinese Journal of Antituberculosis, 2023, 45(9): 826-832.
[6]	Che Beibei, Wang Xiaoping, Qiu Qing, Chen Cheng, Zheng Xubin, Zhao Qi, Xu Biao. A longitudinal study on the characteristics of diagnosis and treatment service of multidrug-resistant/rifampicin resistant pulmonary tuberculosis from 2009 to 2020 in Nantong City, Jiangsu Province [J]. Chinese Journal of Antituberculosis, 2023, 45(9): 864-871.
[7]	Du Yu, Zhang Haipeng, Wang Peng. Research status and application progress of mycobacteria phages [J]. Chinese Journal of Antituberculosis, 2023, 45(9): 897-903.
[8]	Ren Ruyan, Xue Yi, Liang Qian, Huang Hairong. The mechanisms identification of the susceptibility discrepancy to isoniazid among clinical isolates of Mycobacterium kansasii [J]. Chinese Journal of Antituberculosis, 2023, 45(8): 728-733.
[9]	Huang Wenbin, Chen Liping, Zhang Wang, Xiao Ting, Zhang Mane, Wu Dingchang. Establishment of a cross primer isothermal amplification technique for rapid detection of Mycobacterium tuberculosis complex and nontuberculous mycobacteria [J]. Chinese Journal of Antituberculosis, 2023, 45(8): 734-743.
[10]	Zhao Guolian, Lei Qian, Wang Pei, Ren Yunxia, Guan Jing. Value of DNA real-time fluorescence isothermal amplification method and combined testing in early diagnosis of tuberculous pleurisy [J]. Chinese Journal of Antituberculosis, 2023, 45(7): 681-686.
[11]	Wang Nenhan, Tian Lili, Chen Shuangshuang, Zhao Yanfeng, Fan Ruifang, Chen Hao, Ren Yixuan, Zhang Jie, Yi Junli, Yang Xinyu, Yu Lan, Ding Beichuan, Li Chuanyou, Dai Xiaowei. Study on the detection of rifampicin resistance of Mycobacterium tuberculosis in sputum samples using fluorescence PCR probe melting curve technique [J]. Chinese Journal of Antituberculosis, 2023, 45(6): 583-588.
[12]	Wang Boning, Li Tao, Chen Wei. Progress on economic burden of patients with drug-resistant tuberculosis [J]. Chinese Journal of Antituberculosis, 2023, 45(6): 607-612.
[13]	Song Ruixue, Wei Rongrong, Dong Jing, Jia Hongyan, Du Boping, Sun Qi, Xing Aiying, Li Zihui, Zhu Chuanzhi, Zhang Zongde, Pan Liping. The performance of interferon gamma-induced protein 10 mRNA detection technology in auxiliary diagnosis of tuberculosis [J]. Chinese Journal of Antituberculosis, 2023, 45(5): 471-476.
[14]	Yan Xiaojing, Wang Qingfeng, Yang Yang, Chu Naihui, Nie Wenjuan. Diagnostic value of a nanopore sequencing assay of bronchoalveolar lavage fluid in smear-negative pulmonary tuberculosis [J]. Chinese Journal of Antituberculosis, 2023, 45(5): 487-492.
[15]	Fu Liang, Ren Tantan, Zhang Peize, Lu Shuihua. Interpretation of WHO consolidated guidelines on tuberculosis, Module 4: treatment-drug-resistant tuberculosis treatment, 2022 update [J]. Chinese Journal of Antituberculosis, 2023, 45(4): 336-348.