Inagaki Takayuki, Yagi Tetsuya, Ichikawa Kazuya, Nakagawa Taku, Moriyama Makoto, Uchiya Kei-ichi, Nikai Toshiaki, Ogawa Kenji
Department of Clinical Research, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan.
Kekkaku. 2010 Sep;85(9):703-9.
Preventing the spread of drug-resistant tuberculosis is a clinically important challenge. In this effort, rifampicin (RFP)-resistant gene examination by line probe assay (LiPA) was evaluated for its clinical application for rapid detection of tuberculosis.
The RFP-resistant gene was examined in a total of 110 samples of sputum obtained from patients that were definitively diagnosed with pulmonary tuberculosis by auto-LiPA. The difference in detection sensitivity between the results of the smear and culture examinations was evaluated. Culture-positive samples were compared with the results of the drug susceptibility test.
Smear-positive samples were LiPA positive in 69 of 73 samples (sensitivity: 94.5%), and smear-negative samples were LiPA positive in 25 of 37 samples (67.6%). More than half of the samples were LiPA positive, even those that were culture-negative or contaminated. Comparison of the 76 culture-positive samples with the results of the drug susceptibility test found that all samples were wild type among the RFP-sensitive strains. Among the 8 RFP-resistant strains, 6 were mutation type. All samples shown to be mutation type were obtained from patients with multi-drug resistant tuberculosis.
Using LiPA, the amount of smear can be used as a factor for detection of RFP-resistant genes. Detection was possible even with culture-negative and contaminated samples, allowing more rapid diagnosis of patients with multi-drug resistant tuberculosis.
防止耐药结核病的传播是一项具有重要临床意义的挑战。在此过程中，对通过线性探针分析（LiPA）进行利福平（RFP）耐药基因检测在快速检测结核病中的临床应用进行了评估。
对通过自动LiPA确诊为肺结核的患者的110份痰标本进行RFP耐药基因检测。评估涂片和培养检查结果在检测敏感性上的差异。将培养阳性样本与药敏试验结果进行比较。
73份涂片阳性样本中有69份LiPA阳性（敏感性：94.5%），37份涂片阴性样本中有25份LiPA阳性（67.6%）。即使是培养阴性或污染的样本，超过一半也为LiPA阳性。将76份培养阳性样本与药敏试验结果进行比较发现，RFP敏感菌株中的所有样本均为野生型。在8株RFP耐药菌株中，6株为突变型。所有显示为突变型的样本均来自耐多药结核病患者。
使用LiPA，涂片量可作为检测RFP耐药基因的一个因素。即使是培养阴性和污染的样本也能进行检测，从而能更快地诊断耐多药结核病患者。
