间隔区寡核苷酸分型技术在分枝杆菌菌种快速鉴定中的价值

doi:10.3969/j.issn.2095-3755.2019.03.003

摘要/Abstract

摘要：

目的非结核分枝杆菌(NTM)与结核分枝杆菌感染(MTB)所致的临床症状相似,临床鉴别诊断困难,寻找快速有效地鉴定非结核分枝杆菌和结核分枝杆菌对于疾病的正确诊断、治疗具有重要意义。方法选取495例疑似肺结核患者痰液标本,分别采用间隔区寡核苷酸分型(spacer oligonucleotide typing,Spoligotyping)技术(简称“Spoligotyping法”)与BACTEC MGIT 960结核分枝杆菌快速培养法(简称“MGIT 960培养法”)进行检测,比较两种方法对分枝杆菌诊断与菌种鉴定的价值。并且以培养法为参考标准,评估Spoligotyping法诊断的敏感度、特异度、阳性预测值、阴性预测值、符合率和Kappa值。结果培养法检出426例(86.1%,426/495)为结核分枝杆菌,69例(13.9%,69/495)为非结核分枝杆菌;而Spoligotyping法检出结核分枝杆菌420例(84.8%,420/495),非结核分枝杆菌75例(15.2%,75/495)。与MGIT 960培养法相比较,Spoligotyping法诊断的敏感度为96.7%(412/426),特异度为88.4%(61/69),阳性预测值为98.1%(412/420),阴性预测值为81.3%(61/75),诊断符合率为95.6%(473/495),Kappa值为0.821,具有较高的一致性。结论与MGIT 960法相比,间隔区寡核苷酸芯片分型技术可以快速、准确地鉴定结核分枝杆菌及非结核分枝杆菌,该方法能为患者及时诊治提供有效结果。

关键词: 分枝杆菌, 非典型性, 诊断, 鉴别, 寡核苷酸探针, 培养技术, 数据说明, 统计

Abstract:

Objective Clinical symptoms of non-tuberculous mycobacterium (NTM) diseases are similar to Mycobacterium tuberculosis (MTB) diseases, while the medication regimens are different, and it is difficult for differential diagnosis between NTM diseases and tuberculosis. How to identify NTM and MTB quickly and effectively is of great significance for the correct diagnosis and treatment of diseases.Methods Collecting sputum specimens from 495 outpatient and inpatient participants. The specimens were analyzed by spoligotyping and rapid culture of BACTEC MGIT 960 Mycobacterium tuberculosis (BACTEC MGIT 960 culture method ), respectively, and compared the two methods. Evaluated the diagnostic value including the sensitivity, specificity and accuracy of spoligotyping using culture as golden standard.Results Of 495 cases with suspected tuberculosis sputum specimens, specimens of 426 cases (86.1%,426/495) were detected with Mycobacterium tuberculosis and 69 cases (13.9%,69/495) with non-tuberculosis mycobacteria by using culture, and 420 cases (84.8%,420/495) were Mycobacterium tuberculosis and 75 cases (15.2%,75/495) with non-tuberculosis mycobacteria by using spoligotyping. Compared with the MGIT 960 culture method, the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic coincidence rate and Kappa value of the spacer oligonucleotide microarray classification technology were 96.7% (412/426), 88.4% (61/69), 98.1% (412/420), 81.3% (61/75), 95.6% (473/495) and 0.821, respectively.Conclusion Compared with the MGIT 960 culture method, spoligotyping can quickly and accurately identify Mycobacterium tuberculosis and non-tuberculosis mycobacterium with high sensitivity and specificity. This method can provide effective results for timely diagnosis and treatment of patients and has a certain value of clinical promotion.

Key words: Mycobacteria, atypical, Diagnosis, differential, Spoligonucleotide probes, Culture techniques, Data interpretation, statistical

朱晓燕,宋华峰,陈慧,吴敏娟,赵妮娜,胥萍. 间隔区寡核苷酸分型技术在分枝杆菌菌种快速鉴定中的价值[J]. 结核病与肺部健康杂志, 2019, 8(3): 163-167. doi: 10.3969/j.issn.2095-3755.2019.03.003

ZHU Xiao-yan,SONG Hua-feng,CHEN Hui,WU Min-juan,ZHAO Ni-na,XU Ping.. Spoligotyping technology in the rapid identification of Mycobacterium tuberculosis[J]. Journal of Tuberculosis and Lung Health, 2019, 8(3): 163-167. doi: 10.3969/j.issn.2095-3755.2019.03.003

图/表 2

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Spoligotyping法检测的菌种类别	结核分枝杆菌		非结核分枝杆菌
Spoligotyping法检测的菌种类别	例/份数	构成比(%)	例/份数	构成比(%)
结核分枝杆菌北京型	333	67.3	0	0.0
结核分枝杆菌非北京型	87	17.6	0	0.0
鸟分枝杆菌	0	0.0	2	0.4
胞内分枝杆菌	0	0.0	27	5.5
堪萨斯分枝杆菌	0	0.0	29	5.9
戈登分枝杆菌	0	0.0	5	1.0
龟-脓肿分枝杆菌	0	0.0	10	2.0
其他分枝杆菌	0	0.0	2	0.4
合计	420	84.8	75	15.2

Spoligotyping法	MGIT 960培养法		敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	符合率 (%)	Kappa值
Spoligotyping法	结核分枝杆菌 (例/份)	非结核分枝杆菌 (例/份)	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	符合率 (%)	Kappa值
结核分枝杆菌(例/份)	412^a	8^b	96.7	88.4	98.1	81.3	95.6	0.821
非结核分枝杆菌(例/份)	14^c	61^d
合计	426	69