摘要
目的 探讨脑脊液中结核/非结核分枝杆菌(mycobacterium tuberculosis/nontuberculous mycobacteria,MTB/NTM)核酸检测诊断结核性脑膜炎(tuberculous meningitis,TBM)的临床价值.方法 收集120例TBM患者的临床资料,采用随机数字表法将患者分为TBM A组(n=67,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测)和TBM B组(n=53,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、GeneXpert MTB/RIF检测),另收集其他中枢神经系统感染患者脑脊液18例为对照组(C组,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测、GeneXpert MTB/RIF检测).结果 TBM A组脑脊液罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测阳性率分别为13.43％(9/67)、10.45％(7/67)、46.27％(31/67);TBM B组脑脊液罗氏培养、涂片查抗酸菌、GeneXpert MTB/RIF检测阳性率分别为15.09％(8/53)、11.32％(6/53)、47.17％(25/53),GeneXpert MTB/RIF检测阳性病例中利福平耐药基因检测阳性2例.C组脑脊液罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测和GeneXpert MTB/RIF检测均为阴性.结论 MTB/NTM核酸检测与GeneXpert MTB/RIF检测均可辅助早期诊断TBM,相较于后者更经济,并能鉴别非结核分枝杆菌(nontuberculous mycobacteria,NTM)感染,及时减少NTM病误诊、误治,值得临床推广.
Abstract
Objective To investigate the clinical value of Mycobacterium tuberculosis/nontuberculous mycobacteria(MTB/NTM)nucleic acid detection in cerebrospinal fluid for the diagnosis of tuberculous meningitis(TBM).Methods The clinical data of 120 pa-tients with TBM were collected.Patients were divided into two groups using a random number table method:TBM A group(n=67,cere-brospinal fluid routine,biochemical,Roche culture,tuberculous smear,MTB/NTM nucleic acid detection)and TBM B group(n=53,cerebrospinal fluid routine,biochemical,Roche culture,tuberculous smear,GeneXpert MTB/RIF detection),and another 18 cases of cerebrospinal fluid from patients with other central nervous system infections were collected as control group(C group,cerebrospinal fluid routine,biochemical,Roche culture,tuberculous smear,MTB/NTM nucleic acid,GeneXpert MTB/RIF detection.Results The posi-tive rates of Roche culture,tuberculosis smear and MTB/NTM nucleic acid detection of cerebrospinal fluid in TBM A group were 13.43％(9/67),10.45％(7/67)and 46.27％(31/67),respectively.The positive rates of Roche culture,tuberculosis smear and GeneXpert MTB/RIF detection of cerebrospinal fluid in TBM B group were 15.09％(8/53),11.32％(6/53)and 47.17％(25/53),respective-ly.Among the cerebrospinal fluid GeneXpert MTB/RIF positive cases,lifampin resistance gene was positive in 2 patients.In the C group,patients had negative result in Roche culture,tuberculous smear,MTB/NTM nucleic acid detection and GeneXpert MTB/RIF detection.Conclusion MTB/NTM nucleic acid detection and GeneXpert MTB/RIF detection are useful in diagnosing TBM at early stage.MTB/NTM nucleic acid detection more economical than GeneXpert MTB/RIF detection,and can identify non-tuberculous mycobacteria(NTM),and timely reduce the misdiagnosis of NTM disease,which is worthy of clinical promotion.
基金项目
国家自然科学基金(82060002)
国家科技重大专项(2018ZX10302302-004-002)
维普
万方数据