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