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目的探讨荧光定量PCR检测结核分枝杆菌(结核杆菌)DNA在肺结核诊断中的应用价值。方法研究对象为门诊和住院的肺结核患者164例,均做痰涂片找抗酸杆菌、痰结核杆菌DNA检测、痰结核菌培养,按痰涂片找抗酸杆菌结果分为涂阳肺结核组(A组)45例,涂阴肺结核组(B组)119例;对痰结核杆菌DNA检测阳性者,立即再行耐药基因检测;对痰涂片找抗酸杆菌阳性而结核杆菌DNA检测阴性者行非结核分枝杆菌菌种鉴定。结果A组痰结核杆菌DNA阳性率95.6%(43/45),结核菌培养阳性率84.4%(38/45),B组痰结核杆菌DNA阳性率38.6%(46/119),结核菌培养阳性率11.8%(14/119);A组中痰结核杆菌DNA阴性2例,其中1例为胞内分枝杆菌,1例为鸟分枝杆菌;结核杆菌DNA阳性89例中发现耐药22例,其中单耐药12例,多耐药8例,耐多药2例;原始单耐药3例;原始多耐药1例;原始耐多药1例。结论荧光定量PCR检测结核杆菌DNA对诊断结核病有较高的敏感性与特异性,可以缩短诊断时间,提高诊断率,并可及时发现耐药结核菌感染和非结核分枝杆菌感染,为及时调整治疗方案提供依据。
Objective To investigate the diagnostic value of Mycobacterium tuberculosis DNA in the diagnosis of pulmonary tuberculosis by fluorescence quantitative PCR. Methods 164 cases of outpatients and hospitalized patients with pulmonary tuberculosis were sputum smear looking for acid-fast bacilli, sputum tuberculosis DNA detection, sputum TB culture, sputum smear looking for acid-fast bacilli results were divided into smear positive pulmonary tuberculosis group ( A group of 45 cases, smear-negative pulmonary tuberculosis group (B group) 119 cases; positive test for sputum Mycobacterium tuberculosis DNA immediately re-resistant gene test; sputum smear looking positive for acid-fast bacilli and Mycobacterium tuberculosis DNA negative Identification of non-tuberculous mycobacteria. Results The positive rate of TB DNA was 95.6% (43/45) in group A, 84.4% (38/45) in TB culture, 38.6% (46/119) in group B, Rate of 11.8% (14/119); A group of sputum Mycobacterium tuberculosis DNA negative in 2 cases, of which 1 case of Mycobacterium intracellulare, 1 case of Mycobacterium avium; 89 cases of Mycobacterium tuberculosis DNA positive in 22 cases were found resistant , Of which 12 were single-drug resistance, multi-drug resistance in 8 cases, multi-drug resistance in 2 cases; the original single drug resistance in 3 cases; the original multi-drug resistance in 1 case; the original multi-drug resistance in 1 case. Conclusion The detection of Mycobacterium tuberculosis DNA by fluorescence quantitative PCR has a higher sensitivity and specificity for the diagnosis of tuberculosis, which can shorten the diagnosis time and improve the diagnosis rate. Infection with Mycobacterium tuberculosis and non-tuberculous mycobacterium infection can be detected in time, Treatment programs provide the basis.