Xpert MTB/RIF检测技术和MGIT960培养在肺外结核诊断中的比较分析  

Comparative Analysis of Xpert MTB/RIF Technology and MGIT 960 Culture in the Diagnosis of Extrapulmonary Tuberculosis

作　　者：孙秀华[1] 孙娇[1] 孙炳奇[1] Sun Xiuhua;Sun Jiao;Sun Bingqi(The Tenth People' s Hospital of Shenyang,Shenyang,Liaoning,110044,China)

机构地区：[1]沈阳市第十人民医院

出　　处：《当代医学》2019年第17期45-48,共4页Contemporary Medicine

摘　　要：目的评价结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)和BACTEC MGIT960液体培养技术(MGIT960培养)在肺外结核诊断中的临床应用价值。方法收集沈阳市第十人民医院2017年1月至2017年12月住院的高度疑似肺外结核患者标本309例,分别进行Xpert MTB/RIF检测和MGIT960培养,以临床综合诊断为参考标准,对两种方法在各类肺外结核标本中的阳性检出率以及敏感性和特异性进行比较分析,对MGIT960培养阳性的菌株进行药敏试验,并与XpertMTB/RIF法结果进行比较。结果309例患者中,临床确诊肺外结核238例,非结核71例。Xpert MTB/RIF对于肺外结核中不同标本的阳性检出率均高于MGIT960培养法,尤其对脓液的检出具有明显优势。以临床综合诊断为标准,两种方法的总体敏感度、特异度、阳性预测值、阴性预测值以及约登指数分别为65.5%和43.7%、100.0%和93.0%、100.0%和95.4%、46.4%和33.3%、0.66和0.36。两种检测方法比较差异有统计学意义(x^2=22.9,P<0.05)。238例临床确诊肺外结核标本中,MGIT 960培养阳性104例,耐药标本13例,以MGIT960药敏试验为标准,XpertMTB/RIF检测利福平的敏感度和特异度分别为92.3%和100.0%,两种检测方法进行一致性检验k=0.95,两者具有很好的一致性。结论Xpert MTB/RIF对肺外结核病的诊断优于MGIT960培养法,该技术操作简便、阳性检出率较高,对快速诊断肺外结核以及判定利福平耐药情况具有较高的临床应用价值。Objective To evaluate the value of Xpert MTB/RIF techniques and MGIT 960 culture in the diagnosis of extrapulmon ary tuberculosis. Methods Collection 309 clinical samples from the patients who were highly suspected with extrapulmonary tuberculosis and hospitalized in Shenyang Tenth People' s Hospital from January 2017 to December 2017. All the cases were tested for Xpert MTB / RIF detection assay and MGIT960 culture respectively, The positive detection rate, sensitivity and specificity of the two methods in various types of extrapulmonary tuberculosis specimens were compared,and the drug sensitivity test of MGIT 960 cultured positive strains was compared with that of Xpert MTB/RIF. Results 238 were clinically diagnosed with extrapulmonary tuberculosis and 71 with non-tuberculosis in the 309 patients. The positive detection rate of Xpert MTB/RIF was higher than that of MGIT 960 culture method,especially for the detection of pus. Based on the combined clinical diagnosis, the sensitivity, specificity, positive prediction, negative prediction and the reading index of the two methods were 65.5% and 43.7%, 100.0% and 93.0%, 100.0% and 95.4%, 46.4% and 33.3%, 0.66 and 0.36, The diagnostic value of Xpert MTB/RIF assay was significantly different from MGIT 960 culture(x^2=22.9,P<0.05). 104 were positive in MGIT 960 culture and 13 were drug-resistant specimens of the 238 clinically diagnosed extrapulmonary tuberculosis specimens. According to the 960 liquid sensitivity tests result as gold standard,the sensitivity,specificity and kappa of Xpert Mtb/RIF assay were 92.3%, 100.0% and 0.95, the two detection methods has a good consistency. Conclusion Compared the two methods, Xpert MTB/RIF has the advantages of simple and high sensitivity which is an effective method for the rapid diagnosis extrapulmonary tuberculosis and the determination of rifampicin resistance.

关 键 词：肺外结核 XpertMTB/RIF MGIT960培养 

分 类 号：R52[医药卫生—内科学]