支气管肺泡灌洗液XpertMTB/RIF检测在HIV感染者肺结核诊断中的应用价值  

Application value of XpertMTB/RIF in bronchoalveolar lavage fluid in diagnosis of tuberculosis in HIV-1 infected patients

作　　者：蔡侃儒[1] 彭巧丽[1] 汪文斐[1] 刘厚明[1] 张洁云[1] 朱秀云[1] 周泱[1] 王辉[1] CAI Kanru;PENG Qiaoli;WANG Wenfei;LIU Houming;ZHANG Jieyun;ZHU Xiuyun;ZHOU Yang;WANG Hui(Shenzhen Third People＇s Hospital, Guangdong, Shenzhen 518112, China)

机构地区：[1]深圳市第三人民医院

出　　处：《中国艾滋病性病》2018年第6期544-547,共4页Chinese Journal of Aids & STD

基　　金：“十三五国家科技重大专项”(2017ZX10202101-002-004)~~

摘　　要：目的评估支气管肺泡灌洗液（BALF）结核分枝杆菌rpoB基因和突变检测（XpertMTB/RIF）,在诊断艾滋病病毒（HIV）感染合并肺结核中的应用价值。方法对499例HIV感染者BALF标本进行XpertMTB/RIF检测,配对标本同时进行结核分枝杆菌快速培养和药敏试验（BACTEC MGIT 960）、抗酸染色涂片法、实时荧光定量法（PCR-荧光法）检测;同时采用结核分枝杆菌抗原特异性γ-干扰素酶联免疫斑点试验（ELISPOT）检测患者对应外周血标本,比较各种检测方法的阳性率、灵敏度和特异性。结果 BACTEC MGIT 960培养、XpertMTB/RIF、抗酸染色涂片法、PCR-荧光法及ELISPOT检测的阳性率分别为20.4%、13.4%、5.0%、6.6%、22.4%,5种检测方法阳性率差异有统计学意义（χ^2=101.03,P〈0.001）。以传统BACTEC MGIT 960培养阳性并经过菌种鉴定为结核分枝杆菌的79例标本为金标准：XpertMTB/RIF、抗酸染色涂片法、PCR-荧光法、ELISPOT的灵敏度依次为：77.2%、26.3%、38.0%、60.3%;特异性依次为：98.8%、99.2%、99.5%、85.1%;阳性预测值依次为：92.4%、87.0%、93.8%、44.4%;阴性预测值依次为：95.7%、87.5%、89.2%、91.5%。对XpertMTB/RIF、抗酸染色涂片法、PCR-荧光法及ELISPOT四种方法与BACTEC MGIT 960培养进行一致性检验发现,XpertMTB/RIF与BACTEC MGIT 960培养具有最强一致性（Kappa值为0.814）,PCR-荧光法一般（Kappa=0.493）,而抗酸染色涂片法和ELISPOT法最差（Kappa值分别为0.356、0.397）。结论与其他4种常见结核诊断方法相比,支气管肺泡灌洗液XpertMTB/RIF检测技术在HIV感染合并肺结核患者的诊断中具有较高的应用价值,是一种快速省时、敏感性和特异性均高的结核分枝杆菌快速检测方法。Objective To evaluate the value of rpoB gene and mutation detection（XpertMTB/RIF）of mycobacterium tuberculosis（Mtb）by bronchoalveolar lavage fluid（BALF）in diagnosis of pulmonary tuberculosis in HIV-1 infected patients.Methods BALF specimens of 499 HIV-1 infected patients were detected with XpertMTB/RIF.Simultaneously,paired samples were detected for Mtb with rapid culture and drug sensitivity test（BACTEC MGIT960）,acid fast staining,real time fluorescence quantitative PCR（qPCR）,and Mtb antigen-specific interferon gamma enzyme-linked immunospot assay（ELISPOT）.Then the positive rate,sensitivity and specificity of various detection methods were compared.Results The positive rate of BACTEC MGIT 960,XpertMTB/RIF,acid fast staining,qPCR and ELISPOT were 20.4%,13.4%,5.0%,6.6%,22.4% respectively,with a statistically significant difference（χ^2=101.03,P〈0.001）.79 specimens with BACTEC MGIT 960 positive and conformation of Mtb were considered as gold standard.The sensitivity of XpertMTB/RIF,acid fast staining,qPCR,ELISPOT were 77.2%,26.3%,38.0%,and 60.3%;and the specificity were 98.8%,99.2%,99.5%,and 85.1%.The positive predictive value were 92.4%,87.0%,93.8%,and 44.4% and the negative predictive value were 95.7%,87.5%,89.2%,and 91.5%.The consistency test of XpertMTB/RIF,acid fast staining,qPCR and ELISPOT showed that XpertMTB/RIF and BACTEC MGIT 960 had the strongest consistency,with the Kappa value of 0.814,0.356,0.493,and 0.397,respectively.Conclusion Compared with other four common diagnostic methods of Mtb,bronchoalveolar lavage fluid XpertMTB/RIF shows higher value in the diagnosis of pulmonary tuberculosis in HIV positive patients.XpertMTB/RIF is a rapid,time-saving,sensitive and specific method for detection of Mtb.

关 键 词：结核分枝杆菌rpoB基因和突变检测 结核分枝杆菌 艾滋病 支气管肺泡灌洗液 

分 类 号：R373.9[医药卫生—病原生物学] R521[医药卫生—基础医学]