XpertMTB/RIF联合T-SPOT.TB对结核性胸膜炎及其耐药性的临床研究  

Clinical role of Xpert MTB/RIF combined with T-SPOT.TB in diagnosis of tuberculous pleurisy and evaluation of drug resistance

作　　者：孙海柏[1] 张丽霞[1] 刘佳庆[1] 郭明日[1] 李玉明[1] 冯冉冉[1] 刘雅[1] 谢怡 Hai-bai Sun;Li-xia Zhang;Jia-qing Liu;Ming-ri Guo;Yu-ming Li;Ran-ran Feng;Ya Liu;Yi Xie(Tianjin Haihe Hospital,Tianjin 300350,China)

机构地区：[1]天津市海河医院,天津300350

出　　处：《中国现代医学杂志》2018年第11期93-97,共5页China Journal of Modern Medicine

摘　　要：目的探讨利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)、结核感染T细胞斑点检测(T-SPOT.TB)胸腔积液对结核性胸膜炎及其耐药性的临床价值。方法选取2012年6月-2016年10月于天津市海河医院就诊的确诊结核性胸膜炎患者101例;同期选取院内其他疾病合并胸腔积液的患者79例,分别留取胸腔积液标本进行Xpert MTB/RIF和T-SPOT.TB检测,同时完成胸腔积液BACTE C MG1T960液体培养以及药物敏感性等相关性检查,分别与临床诊断和BACTEC MG1T960液体培养作为参考标准进行评价。结果结核性胸膜炎组Xpert MTB/RIF和T-SPOT.TB的敏感性分别为82.18%和88.12%,两组比较,差异有统计学意义(P<0.05),特异性分别为96.10%和98.73%,差异无统计学意义(P>0.05);Xpert MTB/RIF和T-SPOT.TB与BACTEC MU1T960液体培养的Kappa值分别为0.277和0.668;Xpert MTB/RIF在诊断利福平耐药率与BACTEC MU1T960液体培养Kappa值为0.786。结论 T-SPOT.TB的敏感性结合Xpert MTB/RIF的特异性不但缩短了诊断时间而且提高了胸膜炎诊断的准确性,减少误诊率,为结核性胸膜炎的早期诊断提供了有利的帮助,Xpert MTB/RIF能对利福平的耐药性做出快速的判断。Objective To evaluate tuberculosis pleurisy diagnosis and drug resistance in pleural effusion using Xpert Mycobacterium tuberculosis/Rifampicin(Xpert MTB/RIF)combined with enzyme-linked immunospot assay ELISPOT(T-SPOT.TB).Methods In this study,101 cases diagnosed with tuberculous pleurisy in Tianjin Haihe Hospital from June 2012 to October 2016 and 79 cases with pleural effusion due to other diseases during the same period were enrolled.Their pleural effusion samples were collected for Xpert MTB/RIF and T-SPOT.TB detection,and BACTEC MG1T960 pleural liquid culture and drug sensitivity related examination were carried out.Using the result of BACTEC MG1T960 pleural liquid culture as a reference standard,the results of Xpert MTB/RIF and T-SPOT.TB were evaluated.Results In the patients with tuberculous pleurisy,the sensitivity of Xpert MTB/RIF and T-SPOT.TB was 82.18%[95%CI(0.78,0.85)]and 88.12%[95%CI(0.84,0.91)]respectively with statistical difference(χ2=5.591,P=0.018),the specificity was 96.10%[95%CI(0.94,0.98)]and 98.73%[95%CI(0.97,0.99)]without significant difference(χ2=1.022,P=0.312).Using BACTEC MU1T960 pleural liquid culture as thestandard,the kappa values of Xpert MTB/RIF and T-SPOT.TB were 0.277 and 0.668 respectively.Comparing Xpert MTB/RIF with BACTEC MU1T960 liquid culture in the diagnosis of Rifampicin resistance rate,the kappa value was 0.786,which represented the two methods were in excellent agreement.Conclusions The sensitivity of T-SPOT.TB diagnosis combined with the specificity of Xpert MTB/RIF not only shorten the time of diagnosis but also improve the accuracy of diagnosis of tuberculous pleurisy and reduce the misdiagnosis rate,therefore they are useful for early diagnosis of tuberculous pleurisy.Furthermore Xpert MTB/RIF helps to make a quick judgement on the resistance to Rifampicin.

关 键 词：结核性胸膜炎 联合 实时荧光定量核酸扩增技术 结核感染T细胞斑点检测 

分 类 号：R521.7[医药卫生—内科学]