| Objective the gold standard of multi drug resistant tuberculosis in laboratory diagnosis is the liquid culture of BACTEC MGIT960 and the proportional drug sensitivity method.The accuracy rate is high,but it takes a long time to delay the patient's best diagnosis and treatment time,thus delay the condition.In this paper,the rapid detection technique of Bacteriology,immunology and molecular biology was compared with the gold standard.The rapid and accurate method of laboratory identification and drug sensitivity detection was selected to provide reference for early diagnosis.Then through the standardized diagnosis and treatment of the patients with multi drug resistant tuberculosis,the changes of T cells and related cytokines in the body are analyzed,the trend of the changes of cytokines,the evaluation of the recovery of immune function in the body and the effect of diagnosis and treatment are evaluated,and the genes of patients with multi drug resistant tuberculosis are also analyzed.The research of polymorphism and the treatment of gene immunization have opened up new ideas and directions.Methods The multi drug resistant tuberculosis group was selected from March 2016 to March 2017 in the tuberculosis Department of the designated hospital of Tianjin city.73 cases of multi drug resistant tuberculosis were diagnosed.In the laboratory diagnosis,960 liquid culture methods were all positive,Yao Min detected rifampicin and isoniazid were all resistant,and the control group was 73 cases of pulmonary tuberculosis.The first part is the identification of Mycobacterium tuberculosis in the same stage using PCR linear probe hybrids(Polymerase chain reaction linear probe method),sputum smear fluorescent staining,tuberculosis infection T cell detection-immune dot method(T.SPOT-TB),anti tuberculosis mycobacterium antibody(Anti tuberculosis antibody).The four methods were tested at the same time,and compared with the gold standard,the rapid identification method with high specificity and sensitivity was screened.The results of drug sensitivity test and 960 proportion drug sensitivity test were compared and analyzed by PCR linear probe hybrids(linear probe method).The second part: through the systematic diagnosis and treatment,through the use of BD flow cytometry dynamic detection of T cell changes,the analysis of CD4+,CD8+,CD4+/CD8+ and normal control group were compared and analyzed,using Cytometric bead array CBA Technology(Cytometric bead array CBA)technology to detect IL-2,IL-4,IL-6,IL-6,alpha,alpha in different groups of serum.The changes of IFN-gamma and IL-17 level were divided into two groups according to the therapeutic effect,which were divided into two groups.Results 73 cases of multidrug resistant tuberculosis were diagnosed as gold standard by MGIT960 culture and drug sensitivity test.Four rapid examination methods were used to detect and analyze.The results showed that the sensitivity of four kinds of rapid laboratory method linear probe method,tuberculosis antibody,T-SPOT.TB,sputum smear detection was 82.19%,95%CI(77)..7%,86.6%,56.16%,95%CI(50.4%,61.9%),43.84%,95%CI(38.1%,49.6%),23.29%,95%CI(18.3%,28.2%),the difference is statistically significant,the specificity of the detection is 95.89%,95%CI(93.6%,98.2%),95%CI,95%CI,95%CI(95%CI),linear probe The difference between the method and TB antibody and T-SPOT.TB was statistically significant,and there was no significant difference between the two methods.The operation time of the four methods was compared and analyzed.The results were as follows: 2 hours for acid resistant sputum smear,2 hours for linear probe technique,3 hours for detection of Mycobacterium tuberculosis and 24 hours for T.SPOT-TB,so it was recently developed in the rapid diagnosis method as compared with linear probe.The detection project is relatively high in both sensitivity and specificity,and the detection time is relatively short.The linear probe method is recommended as the first choice for rapid identification.At the same time,the drug resistance of Mycobacterium tuberculosis was measured by the MGIT960 ratio method.The linear probe rifampin resistance rate was 82.19%,the control group was 100% and the Kappa value was 0.701.The two methods had high consistency in the detection of rifampicin resistance,and the linear probe method of isoniazid resistance was 83.56.The sensitivity of the control group was 100% and the Kappa value was 0.722.The two methods had high consistency in the detection of isoniazid resistance,so the linear probe was selected as the first selection method for the rapid diagnosis of drug-resistant tuberculosis and carried out clinical promotion.The T cell subgroup of the patients with multi drug resistant tuberculosis was compared with the normal control group.There was no statistical difference between the two groups in the total T cell detection.There was no statistical difference between the two groups and the CD4+T cells compared with the control group.The CD8+T cells were higher than the control group,and the P<0.05 was higher than the control group.There was a statistical difference.There was no statistical difference in the occurrence of CD4+/CD8+,and there was no statistical difference in the occurrence of CD4+/CD8+.IL-6,TNF-alpha,IL-17,IL-10,IFN-gamma,IL-2 in each stage showed regular changes,and gradually recovered to the normal level,which was regarded as the effective treatment and the sustainable original treatment scheme,indicating the gradual recovery of the immune system,and the training of the patients with 7 kinds of cytokines before,2 months and 6 months after drug use.From two months to six months June,the change trend of drug use showed the opposite trend From two months to six months June,suggesting that the possible treatment was not successful.The Mycobacterium tuberculosis in the body was still not reduced,and the immune function was still not completely restored.Patients with primary treatment: the patients' clinical symptoms were heavier and the immune response was stronger,so the content of IL-17 and IFN-gamma was higher with the change of the condition.The retreated group: the memory type T cells released a large number of cytokines,and the content of IL-2 and IL-4 was higher.Conclusion there are several rapid detection methods for rapid diagnosis of Mycobacterium tuberculosis in multi drug resistant tuberculosis. |
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