Phetsuksiri Benjawan, Klayut Wiphat, Rudeeaneksin Janisara, Srisungngam Sopa, Bunchoo Supranee, Toonkomdang Sarawut, Wongchai Thanee, Nakajima Chie, Suzuki Yasuhiko
Ministry of Public Health, National Institute of Health, Department of Medical Sciences, Nonthaburi, Thailand.
Mae Sot Hospital, Department of Medical Technology, Tak, Thailand.
Rev Inst Med Trop Sao Paulo. 2020 Jun 5;62:e36. doi: 10.1590/S1678-9946202062036. eCollection 2020.
Simple, low-cost and effective diagnostic tests for tuberculosis (TB) are needed especially in TB-high burden settings. The present study evaluated the performance of an in-house loop-mediated isothermal amplification (LAMP) for diagnosing TB by comparing it to Xpert MTB/RIF, microscopy and culture. In Thailand, a total of 204 excess sputum samples volume after the processing of cultures were used for Mycobacterium tuberculosis (MTB) detection by Xpert MTB/RIF and LAMP. Based on culture results as the gold standard, the overall sensitivity of LAMP and Xpert MTB/RIF were 82.1% (126/153; 95% confidential interval [CI]: 75.4-88.98%) and 86.9 % (133/153; 95% CI: 80.5-90.8%) respectively, and the specificity of both tests was 100% (51/51; 95% CI: 93.0-100.0%). In comparison with Xpert MTB/RIF, the sensitivity and specificity of LAMP were 94.7% (126/133; 95% CI: 89.5-97.9%), and 100.0% (73/73; 95% CI: 94.9-100.0%), respectively. The average threshold cycle (Ct) of Xpert MTB/RIF detection for positive and negative LAMP results was statistically different, of 18.4 and 27.0, respectively (p < 0.05). In comparison with the acid-fast staining technique, and analyzing LAMP and Xpert MTB/RIF in smear-negative/culture-positive specimens, there was an increase of the detection rate by 47.7% (21/44) and 54.6% (24/44). The diagnostic sensitivity and specificity of LAMP appeared to be comparable to those of Xpert MTB/RIF. We claim that this LAMP has potential to provide a sensitive diagnostic test for the rapid TB diagnosis. It allowed a fast detection of MTB before the cultures and it could be used in resource-limited laboratory settings.
尤其在结核病高负担地区,需要简单、低成本且有效的结核病诊断检测方法。本研究通过将一种内部环介导等温扩增技术(LAMP)与Xpert MTB/RIF、显微镜检查和培养法进行比较,评估了其诊断结核病的性能。在泰国,共有204份培养处理后的多余痰液样本用于通过Xpert MTB/RIF和LAMP检测结核分枝杆菌(MTB)。以培养结果作为金标准,LAMP和Xpert MTB/RIF的总体灵敏度分别为82.1%(126/153;95%置信区间[CI]:75.4 - 88.98%)和86.9%(133/153;95% CI:80.5 - 90.8%),两种检测方法的特异性均为100%(51/51;95% CI:93.0 - 100.0%)。与Xpert MTB/RIF相比,LAMP的灵敏度和特异性分别为94.7%(126/133;95% CI:89.5 - 97.9%)和100.0%(73/73;95% CI:94.9 - 100.0%)。Xpert MTB/RIF检测LAMP阳性和阴性结果的平均阈值循环数(Ct)在统计学上有差异,分别为18.4和27.0(p < 0.05)。与抗酸染色技术相比,在涂片阴性/培养阳性标本中分析LAMP和Xpert MTB/RIF,检测率分别提高了47.7%(21/44)和54.6%(24/44)。LAMP的诊断灵敏度和特异性似乎与Xpert MTB/RIF相当。我们认为这种LAMP有潜力为结核病的快速诊断提供一种灵敏的诊断检测方法。它能够在培养之前快速检测出MTB,并且可用于资源有限的实验室环境。