用于检测复合物的线性探针分析：来自印度中部的经验。
Line probe assay for detection of complex: An experience from Central India.
作者信息
Desikan Prabha, Panwalkar Nikita, Mirza Shaina Beg, Chaturvedi Aparna, Ansari Kudsia, Varathe Reeta, Chourey Manju, Kumar Pradeep, Pandey Manoj
机构信息
Department of Microbiology, Bhopal Memorial Hospital & Research Centre, Bhopal, India.
Department of Surgical Oncology, Bhopal Memorial Hospital & Research Centre, Bhopal, India.
出版信息
Indian J Med Res. 2017 Jan;145(1):70-73. doi: 10.4103/ijmr.IJMR_831_14.
BACKGROUND & OBJECTIVES: Mycobacterium tuberculosis complex may sometimes not be detected in sputum samples of suspected multidrug-resistant tuberculosis (MDR-TB) patients by line probe assay (LPA) even though they are smear positive for acid-fast bacilli (AFB). This retrospective analysis was attempted to understand and document our experience with LPA for detection of M. tuberculosis complex and diagnosis of MDR-TB under programmatic conditions.
METHODS
One thousand two hundred and ninety four sputum samples of MDR-TB suspects that were smear positive for AFB, and received from February to November 2013, were tested by LPA for the presence of M. tuberculosis complex and resistance to isoniazid (INH) and rifampicin as per the diagnostic mandate of an accredited reference laboratory. As per the mandate, those samples that were negative for M. tuberculosis complex were cultured, and the growth again tested by LPA. A retrospective analysis of the results was carried out.
RESULTS
M. tuberculosis complex could be detected in 1217 (94.04%) but not in 77 (5.9%) of smear-positive sputum samples. Of the 1217 positive samples, 232 (19.1%) were MDR, 130 (10.6%) were rifampicin monoresistant and 101 (8.3%) were INH monoresistant. Seven hundred and fifty four (61.9%) strains were found to be pansensitive. Overall, 5.1 per cent of the sputum samples were negative for M. tuberculosis complex by LPA and culture. In at least 10 (0.77%) sputum samples smear positive for AFB, M. tuberculosis complex could not be identified by LPA though M. tuberculosis was present, as evidenced by culture positivity.
INTERPRETATION & CONCLUSIONS: LPA is a robust technique for diagnosis of drug-resistant TB that has provided the basis for rapid and effective control of drug-resistant TB in India. While the reasons for concomitantly negative LPA and culture results of smear-positive sputum samples from MDR-TB suspects may be many, the possible presence of non-tubercular mycobacteria in these samples and the likelihood of inappropriate therapy in these patients cannot be ruled out. Addition of culture to the diagnostic algorithm may enhance the diagnostic yield.
背景与目的
在疑似耐多药结核病（MDR-TB）患者的痰标本中，有时采用线性探针分析（LPA）检测不到结核分枝杆菌复合群，即便这些标本的抗酸杆菌（AFB）涂片呈阳性。本回顾性分析旨在了解并记录我们在项目条件下使用LPA检测结核分枝杆菌复合群及诊断MDR-TB的经验。
方法
按照一家认可的参考实验室的诊断要求，对2013年2月至11月间收到的1294份AFB涂片阳性的MDR-TB疑似患者的痰标本进行LPA检测，以确定是否存在结核分枝杆菌复合群以及对异烟肼（INH）和利福平的耐药情况。根据要求，对结核分枝杆菌复合群检测呈阴性的标本进行培养，并再次用LPA检测培养物的生长情况。对结果进行回顾性分析。
结果
在1294份AFB涂片阳性的痰标本中，1217份（94.04%）检测到结核分枝杆菌复合群，77份（5.9%）未检测到。在1217份阳性标本中，232份（占19.1%）为MDR，130份（占10.6%）为利福平单耐药，101份（占8.3%）为INH单耐药。754份（占61.9%）菌株为全敏感。总体而言，5.1%的痰标本通过LPA和培养检测结核分枝杆菌复合群呈阴性。在至少10份（占0.77%）AFB涂片阳性的痰标本中，尽管培养结果呈阳性证明存在结核分枝杆菌，但LPA未能鉴定出结核分枝杆菌复合群。
解读与结论
LPA是一种用于诊断耐药结核病的可靠技术，为印度快速有效控制耐药结核病提供了依据。虽然MDR-TB疑似患者AFB涂片阳性的痰标本LPA和培养结果同时为阴性的原因可能有很多，但不能排除这些标本中可能存在非结核分枝杆菌以及这些患者接受不恰当治疗的可能性。在诊断流程中增加培养可能会提高诊断率。
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