利福平耐药实时荧光定量核酸扩增技术在肺结核临床路径中的应用

doi:10.6040/j.issn.1671-7554.0.2018.152

摘要/Abstract

摘要： 目的评估利福平耐药实时荧光定量核酸扩增技术(Xpert)在肺结核临床路径中的应用价值。方法收集2015年1月1日至2017年6月30日在昆明市第三人民医院结核一科收治的疑似肺结核住院患者的资料,将入院当天Xpert检测结果为阳性的归入实验组(初治、复治、耐多药肺结核)1 386例,没有行Xpert检测的患者归入对照组(初治、复治、耐多药肺结核)1 360例,实验组根据Xpert检测结果制定治疗方案进行治疗,对照组按常规方法进行治疗。分析对比两种临床路径治疗的总效果,包括患者住院天数、检测治疗费用、不良反应、患者及家属满意度等。结果实验组和对照组耐多药肺结核患者的住院天数、治疗周期、检测费用及诊治总费用均高于复治患者,而复治患者高于初治患者(P<0.001)。实验组初治患者除检测费用外其余3项指标均低于对照组;实验组复治患者4项指标均低于对照组;而实验组耐多药肺结核患者除治疗周期外其余3项指标均低于对照组。各组患者中均出现肝功能异常人群,实验组耐多药结核患者的肝功能异常比率低于对照组,差异有统计学意义(χ2=18.325, P<0.001)。在就诊流程方便性和检测结果报告时间调查中发现实验组的满意度高于对照组,差异有统计学意义(P<0.001)。两组中耐多药肺结核患者及家属对诊疗总花费、患者健康情况及住院治疗天数的满意度不高,对照组中耐多药肺结核患者的满意度得分低于实验组,差异有统计学意义(P<0.001),且对诊疗总花费非常不满意。结论 Xpert技术在临床路径应用后对肺结核特别是针对耐多药肺结核的诊疗具有良好的疗效,不仅降低了治疗总费用,缩短住院时间,而且减少了药物滥用及不良反应的发生,同时提高了患者及家属的满意度。

关键词: 利福平耐药实时荧光定量核酸扩增技术, 结核分枝杆菌, 耐多药肺结核, 临床路径

Abstract: Objective To explore the applicative value of gene Xpert mycobacterium tuberculosis DNA and resistance to rifampicin assay(Gene Xpert MTB/RIF, shortened for Xpert)for the rapid detection of pulmonary tuberculosis in clinical practice. Methods Suspected tuberculosis inpatients admitted during Jan. 2015 and June 2017 were enrolled. Mycobacterium tuberculosis and rifampin resistance tests were performed with Xpert on the day of admission. Patients examined with Xpert were included in the experiment group(n=1 386, including patients receiving initial treatment, patients receiving retreatment and patients with multi-drug resistant tuberculosis), and those did not receive Xpert examination were involved in the control group(n=1 360, including patients receiving initial treatment, patients receiving retreatment and patients with multi-drug resistant tuberculosis). The experiment group received treatment based on the Xpert results, while the control group received routine treatment. The therapeutic effects of the two groups were compared, 山东大学学报 (医学版)56卷6期 -李晓非,等.利福平耐药实时荧光定量核酸扩增技术在肺结核临床路径中的应用 \=- including hospital stay, medical costs, side effects and satisfaction from the patients and their families. Results In both of the experiment group and control group, patients with multi-drug resistant tuberculosis had longer hospital stay and higher medical costs, followed by patients receiving retreatment and then patients receiving initial treatment(P<0.001). For patients receiving initial treatment, except for the medical costs, the other three indexes were longer/higher in the experiment group than in the control group. For patients receiving retreatment, the four indexes were shorter/lower in the experiment group than in the control group. For patients with multi-drug resistant tuberculosis, except for the hospital stay, the remaining three indexes were shorter/lower in the experiment group than in the control group. Patients with abnormal liver function were detected in both groups. Rate of hepatic dysfunction among patients with multi-drug resistant tuberculosis was lower in the experiment group than in the control group, and the difference was statistically significant (χ2=18.325, P<0.001). The experiment group had higher satisfaction with the treatment process and time needed for test result report than the control group, and the differences were significant(P<0.001). In the experiment group, patients with multi-drug resistant tuberculosis and their families had higher satisfaction with the medical costs, patients’ health status and hospital stay than those in the control group (P<0.001). Some patients in the control group were strongly discontented with the medical costs. Conclusion Xpert is effective in the diagnosis and treatment of tuberculosis, especially for the early detection and treatment of multi-drug resistant tuberculosis. It can reduce the total medical costs, decrease drug abuse and side effects, shorten the hospital stay, and improve patients’ and their families’ satisfaction.

Key words: Gene Xpert mycobacterium tuberculosis DNA and resistance to rifampicin assay, Mycobacterium tuberculosis, Multi-drug resistant tuberculosis, Clinical pathway

中图分类号:

R446

李晓非,黄山,欧阳兵,余婷婷,梁桂亮,王霖. 利福平耐药实时荧光定量核酸扩增技术在肺结核临床路径中的应用[J]. 山东大学学报 (医学版), 2018, 56(6): 35-40.

LI Xiaofei, HUANG Shan, OUYANG Bing, YU Tingting, LIANG Guiliang, WANG Lin. Applicative value of gene Xpert MTB/RIF for the rapid detection of pulmonary tuberculosis in the clinical pathway[J]. Journal of Shandong University (Health Sciences), 2018, 56(6): 35-40.

参考文献

[1] 喻国旗, 雷明智, 魏怡, 等. 2004-2015年中国大陆地区肺结核流行的时空分布特征[J]. 现代预防医学, 2017, 44(20): 3649-3654. YU Guoqi, LEI Mingzhi, WEI Yi, et al. Characteristic of spatial-temporal distribution of pulmonary tuberculosis in mainland China from 2004 to 2015[J]. Modern Preventive Medicine, 2017, 44(20): 3649-3654.
[2] 肖和平, 方勇. 多学科协作开启结核病防治新时代[J]. 中华结核和呼吸杂志, 2017, 40(5): 321-322.
[3] 陈利民, 柴志凯, 范月玲, 等. 山西省实施新型结核病防治服务模式效果评价[J]. 中国药物与临床, 2017, 17(2): 285-287.
[4] 吴腾燕, 刘飞鹰, 曹云飞, 等. 广西各级结核病防治机构人力资源的现状分析[J]. 现代预防医学, 2013, 40(13): 2448-2450, 2457. WU Tengyan, LIU Feiying, CAO Yunfei, et al. Analysis on the current situation of human resource in control and treatment organizations for tuberculosis in Guangxi[J]. Modern Preventive Medicine, 2013, 40(13): 2448-2450, 2457.
[5] Mindru R, Spinu V, Popescu O, et al. LPA or GeneXpert in the diagnosis of multidrug-resistant tuberculosis[J]. Pneumologia, 2016, 65(2): 76-80.
[6] 何坤,夏勇,袁国丹.Xpert MTB/RIF技术在早期诊断耐药结核中的应用研究[J]. 重庆医学, 2017, 26: 3707-3708.
[7] 王黎霞. 结核分枝杆菌药物敏感性实验标准化操作程序及质量保证手册[M]. 北京: 人民卫生出版社, 2013: 140.
[8] Kaur R, Jindal N, Arora S, et al. Epidemiology of rifampicin resistant tuberculosis and common mutations in rpoB gene of mycobacterium tuberculosis: a retrospective study from six districts of punjab(India)using Xpert MTB/RIF assay[J]. J Lab Physicians, 2016, 8(2): 96-100.
[9] Detjen AK, DiNardo AR, Leyden J, et al. Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis[J]. Lancet Respir Med, 2015, 3(6): 451-461.
[10] Rufai SB, Singh A, Kumar P, et al. Performance of Xpert MTB/RIF assay in diagnosis of pleural tuberculosis by use of pleural fluid samples[J]. J Clin Microbiol, 2015, 53(11): 363-368.
[11] 张玉华, 张国钦, 钟达, 等. 应用Xpert MTB/RIF法对我国肺结核诊断及利福平耐药检测的Meta分析[J]. 现代预防医学, 2017, 44(12): 2116-2119, 2130.
[12] Héquet D, Huchon C, Baffert S, et al. Preoperative clinical pathway of breast cancer patients: determinants of compliance with EUSOMA quality indicators[J]. Br J Cancer, 2017, 116(11): 1394-1401.
[13] Ueda A, Saito T, Ueda M, et al. Introduction and PDCA-Management of a liaison-clinical pathway with cancer patients after a curative operation[J]. Gan To Kagaku Ryoho, 2015, 42(10): 1197-1201.
[14] Naik-Mathuria BJ, Rosenfeld EH, Gosain A, et al. Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries based on a multicenter analysis: a pediatric trauma society collaborative[J]. J Trauma Acute Care Surg, 2017, 83(4): 589-596.
[15] Rutman L, Klein EJ, Brown JC, et al. Clinical pathway produces sustained Improvement in acute gastroenteritis care[J]. Pediatrics, 2017, 140(4): 89-93.
[16] Bryan MA, Desai AD, Wilson L, et al. Association of bronchiolitis clinical pathway adherence with length of stay and costs[J]. Pediatrics, 2017, 139(3): 34-32.
[17] Furuhata H, Araki K, Ogawa T, et al. Effect on completion of clinical pathway for Improving clinical indicator: cases of hospital stay, mortality rate, and comprehensive-volume ratio[J]. J Med Syst, 2017, 41(12): 206-208.
[18] Yerrabothala S, Talebian L, Klinker K, et al. Extracorporeal photopheresis for graft versus host disease: identifying a clinical pathway and associated resource utilization[J]. J Clin Apher, 2017, 83(4): 589-596.
[19] van der Kolk M, van den Boogaard M, Becking-Verhaar F, et al. Implementation and evaluation of a clinical pathway for pancreaticoduodenectomy procedures: a prospective cohort study[J]. J Gastrointest Surg, 2017, 21(9): 1428-1441.
[20] 路阳, 李中凯, 陆晨, 等. 县级医院推行临床路径管理障碍分析和对策研究[J]. 中国卫生质量管理, 2016, 23(1): 22-26. LU Yang, LI Zhongkai, LU Chen, et al. Obstacles analysis and countermeasures of clinical pathway implementation in county hospitals[J]. Chinese Health Quality Management, 2016, 23(1): 22-26.
[21] 洪小丹, 林美娥, 梁玲飞. 临床护理路径用于后腹腔镜肾癌根治术的效果评价[J]. 浙江医学, 2015, 37(2): 166-168.
[22] 丁丽萍, 朱婧, 姚炯.临床路径变异因素的原因探讨[J]. 中国病案, 2015, 16(3): 22-24. DING Liping, ZHU Jing, YAO Jiong. Reason exploration of the variation of clinical pathways[J]. Chinese Medical Record, 2015, 37(2): 166-168.
[23] 苏俊华, 黄山, 余婷婷. 耐多药结核分枝杆菌92株对二线抗结核药耐药情况分析[J].实用医技杂志, 2016, 23(6): 581-583. SU Junhua, HUANG Shan, YU Tingting. Analysis of resistance to second-line drugs in 92 strains of multidrug resistance mycobacterium tuberculosis[J]. Journal of Practical Medical Techniques, 2016, 23(6): 581-583.

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