四种实验室检查方法对结核分枝杆菌检测价值探讨  

Value of four laboratory tests for the detection of Mycobacterium tuberculosis

作　　者：刘耐 邢宝春 LIU Nai;XING Bao-chun(Department of Fifth Internal Medicine Tuberculosis,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院结核内五科,河南郑州450000

出　　处：《社区医学杂志》2022年第23期1342-1345,共4页Journal Of Community Medicine

摘　　要：目的探讨实时荧光定量PCR(FQ-PCR)、实时荧光定量核酸扩增(Gene-Xpert)、抗酸染色涂片、改良罗氏固体培养用于结核分枝杆菌检测的价值。方法选取2019-04-01-2021-04-01河南省胸科医院收治的244例呼吸系统疾病患者为研究对象,其中肺结核患者109例,非肺结核患者135例。所有患者均在清晨行常规口腔清洁后采集痰标本,分别行FQ-PCR、Gene-Xpert、抗酸染色涂片、改良罗氏固体培养检测结核分枝杆菌。通过一致性分析上述方法检测结核分枝杆菌及利福平的耐药性效能。结果一致性分析结果显示,FQ-PCR、Gene-Xpert、抗酸染色涂片、改良罗氏固体培养检测结核分枝杆菌的灵敏度分别为86.24%、85.32%、74.31%、80.73%,特异度分别为91.11%、90.37%、77.04%、79.26%,准确率分别为88.93%、88.11%、75.82%、79.92%,阳性预测值分别为88.68%、87.74%、72.32%、75.86,阴性预测值分别为89.13%、88.41%、78.79%、83.59%,Kappa值分别为0.776、0.759、0.523、0.602。一致性分析结果显示,FQ-PCR、Gene-Xpert、改良罗氏固体培养检测利福平耐药灵敏度分别为78.26%、73.91%、43.48%,特异度分别为82.56%、88.37%、97.67%,准确率分别为81.65%、85.32%、86.24%,阳性预测值分别为54.55%、62.96%、83.33%,阴性预测值分别为93.42%、92.68%、86.60%,Kappa值分别为0.525、0.586、0.603。结论FQ-PCR、Gene-Xpert技术均可用于肺结核患者结核分枝杆菌及利福平耐药性检测,对疾病的诊断及用药方式的选择具有重要意义。Objective To explore the value of real-time fluorescence quantitative PCR(FQ-PCR),real-time fluorescence quantitative nucleic acid amplification(Gene-Xpert),acid fast staining smear and improved Roche solid culture for the detection of Mycobacterium tuberculosis.Methods The clinical data of 244 patients with respiratory diseases admitted to Henan Provincial Chest Hospital from April 1,2019 to April 1,2021 were the subjects of study,including 109 patients with tuberculosis and 135 patients without tuberculosis.Sputum specimens were collected after routine oral cleaning in the morning from all patients,and Mycobacterium tuberculosis was detected by FQ-PCR,Gene-Xpert,acid-fast staining smear and modified Roche solid culture,respectively.Consistency analysis was used to analyze the effectiveness of the above methods in detecting Mycobacterium tuberculosis and the drug resistance of rifampicin.Results Consistency analysis showed that the sensitivity of FQ-PCR,Gene-Xpert,acid-fast staining smear and modified Roche solid culture in detection of Mycobacterium tuberculosis was 86.24%,85.32%,74.31%,and 80.73%,and the specificity of the four methods was 91.11%,90.37%,77.04%,and 79.26%,respectively.The accuracy rate was 88.93%,88.11%,75.82%and 79.92%,the positive predictive value was 88.68%,87.74%,72.32%and 75.86%,the negative predictive value was 89.13%,88.41%,78.79%and 83.59%,Kappa value were 0.776,0.759,0.523 and 0.602.Consistency analysis showed that the sensitivity of FQ-PCR,Gene-Xpert and improved Roche solid culture for the detection of rifampin resistance was 78.26%,73.91%and 43.48%,the specificity was 82.56%,88.37%and 97.67%,and the accuracy was 81.65%,85.32%and 86.24%.Positive predictive values were 54.55%,62.96%,and 83.33%;negative predictive values were 93.42%,92.68%,and 86.60%,Kappa value were 0.525,0.586 and 0.603.Conclusion Both FQ-PCR and Gene-Xpert technologies can be used to detect Mycobacterium tuberculosis and drug resistance of rifampicin in patients with tuberculosis,which is of great significance for t

关 键 词：肺结核 结核分枝杆菌 实时荧光定量PCR 实时荧光定量核酸扩增 抗酸染色涂片 改良罗氏固体培养 

分 类 号：R446.5[医药卫生—诊断学]