GeneXpert实时荧光定量PCR在诊断艰难梭菌感染中的临床应用
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首都医科大学附属北京友谊医院 “种子计划”人才项目(YYZZ2018B01)。


Clinical application of GeneXpert real-time fluorescence quantitation PCR in the diagnosis of Clostridium difficile infection
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    摘要:目的?评价GeneXpert实时荧光定量PCR法在诊断艰难梭菌感染中的应用价值。方法?收集住院腹泻患者非重复粪便标本296份,同时进行GeneXpert试验和产毒素培养(toxigenic culture, TC)。TC包括厌氧培养、菌株基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)鉴定、PCR扩增艰难梭菌毒素基因。以TC结果为参考,评价GeneXpert试验的敏感性、特异性、阳性预测值、阴性预测值,并评价GeneXpert试验和TC 2种方法结果的一致性。结果?GeneXpert试验的敏感性、特异性、阳性预测值和阴性预测值分别为98.5%、92.6%、91.7%和98.7%。GeneXpert试验与TC一致性好(Kappa=0.905)。GeneXpert试验报告2株RT027型高毒力菌株,经核糖体分型确证为RT027型艰难梭菌。结论?GeneXpert实时荧光定量PCR可快速、准确检测粪便标本中的艰难梭菌毒素基因,且可报告高毒力RT027型菌株,具有重要的临床应用价值。

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    Abstract:?Objective?To evaluate the application value of GeneXpert real-time fluorescence quantitation PCR(GeneXpert PCR)in the diagnosis of?Clostridium?difficile?infection.Methods?A total of 296 unrepeated stool specimens were collected from the diarrhea inpatients, and toxigenic culture(TC)and GeneXpert PCR were performed, respectively.For TC, after anaerobic culture, bacterial clones were identified by the matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF MS)and the toxin genes of?Clostridium?difficile?were?detected by PCR.Taking TC results as a reference, the sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert PCR and the consistency of the results between GeneXpert PCR and TC were evaluaed.Results?The sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert PCR were 98.5%, 92.6%, 91.7% and 98.7%, respectively, and there was good consistency between TC and GeneXpert PCR(Kappa=0.905).Two strains of RT027 with high virulence were detected by GeneXpert PCR, and were confirmed as RT027 type?Clostridium?difficile?by Ribotyping.Conclusion?GeneXpert real-time fluorescence quantitation PCR is able to detect the toxin genes of?Clostridium?difficile?in stool specimens rapidly and accurately, and able to identify the RT027 strains with high virulence, which has important clinical application value.

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程敬伟,刘畅,肖盟,孙宏莉,王瑶,杨启文,徐英春. GeneXpert实时荧光定量PCR在诊断艰难梭菌感染中的临床应用[J].临床检验杂志,2021,39(1):17-21

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  • 收稿日期:2020-10-24
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  • 在线发布日期: 2021-03-19
  • 出版日期: 2021-01-28
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