全自动半巢式实时荧光定量PCR技术检测BALF诊断肺结核的价值  

Detection of the Value of BALF in the Diagnosis of Pulmonary Tuberculosis by Automatic Semi-nested Real-time PCR

作　　者：胡立珍 周广信[2] 霍丽丽[3] 陈子芳 HU Li-zhen;ZHOU Guang-xin;HUO Li-li;CHEN Zi-fang(Department of Clinical Laboratory,Binzhou Central Hospital/Binzhou City Tuberculosis Prevention Hospital,Binzhou 251700,Shandong,China;Department of Oncology,Binzhou Central Hospital/Binzhou City Tuberculosis Prevention Hospital,Binzhou 251700,Shandong,China;Department of Preventive Defense,Binzhou Central Hospital/Binzhou City Tuberculosis Prevention Hospital,Binzhou 251700,Shandong,China)

机构地区：[1]山东省滨州市中心医院/滨州市结核病防治院检验科,山东滨州251700 [2]山东省滨州市中心医院/滨州市结核病防治院肿瘤科,山东滨州251700 [3]山东省滨州市中心医院/滨州市结核病防治院结防科,山东滨州251700

出　　处：《医学信息》2019年第15期165-167,共3页Journal of Medical Information

摘　　要：目的探讨全自动半巢式实时荧光定量PCR技术(GeneXpert MTB/RIF)检测肺胞灌洗液(BALF)诊断肺结核的价值。方法采集2016年6月~2018年6月滨州市结核病防治院已经确诊的住院菌阴肺结核269例设为实验组,另收集其他肺部疾病患者87例设为对照组。利用支气管镜术收集肺胞灌洗液;肺胞灌洗液采用涂片法、培养法和GeneXpert MTB/RIF法3种方法检测结核分枝杆菌,分别对其阳性率及检测菌量进行比较。结果 BALF经涂片、培养和GeneXpert MTB/RIF3种方法检测,敏感度分别为23.05%、33.83%和62.08%,特异度分别为97.70%、97.70%和100.00%。GeneXpert MTB/RIF法分别与涂片法和培养法结果比较,差异均有统计学意义(P<0.05);涂片法与培养法结果比较,差异有统计学意义(P<0.05);对照组涂片和培养均出现2例阳性者,而GeneXpert MTB/RIF为阴性;涂片和培养相同的2例阳性者,经基因芯片检测确定为NTM。269例菌阴肺结核BALF涂片阴性者207例,207例涂片阴性者经GeneXpert MTB/RIF法检测呈阳性者105例,其中GenXpert MTB/RIF 法“极低”量级50例,占47.62%。269例菌阴肺结核BALF培养阴性者178例,178例涂片阴性者经GeneXpert MTB/RIF法检测呈阳性者76例,其中GenXpert MTB/RIF 法“极低”量级37例,占48.68%。结论 GeneXpert MTB/RIF技术结核分枝杆菌阳性检出率高于涂片和培养法,对早期诊断肺结核具有一定的临床应用价值,且操作简单、快速,值得推广。Objective To investigate the value of automatic semi-nested real-time PCR (GeneXpert MTB/RIF) in the detection of pulmonary lavage fluid (BALF) for the diagnosis of tuberculosis.Methods From June 2016 to June 2018, 269 cases of hospitalized sputum tuberculosis diagnosed by Binzhou City Tuberculosis Hospital were set as experimental group, and 87 cases of other lung diseases were collected as control group. The lung cell lavage fluid was collected by bronchoscopy. The lung cell lavage fluid was tested by smear method, culture method and GeneXpert MTB/RIF method to detect Mycobacterium tuberculosis. The positive rate and the amount of bacteria were compared.Results BALF was tested by smear, culture and GeneXpert MTB/RIF in three methods. The sensitivity was 23.05%, 33.83% and 62.08%, respectively, and the specificities were 97.70%, 97.70% and 100%, respectively. The results of GeneXpert MTB/RIF method were statistically significant compared with the results of smear method and culture method (P<0.05). The difference between smear method and culture method was statistically significant (P<0.05). Two positive cases were found in the smear and culture, while the GeneXpert MTB/RIF was negative;the two smears and the same positive ones were identified as NTM by gene chip detection.207 of the 269 cases of BALF smear negative for bacterial negative pulmonary tuberculosis were detected by GeneXpert MTB/RIF method, and 105 of the 207 cases were positive, among which 50 cases (47.62%) were "extremely low" in GenXpert MTB/RIF method.178 of the 269 cases were negative in BALF culture, and 76 of the 178 cases were positive by GeneXpert MTB/RIF method, among which 37 cases (48.68%) were "extremely low" in GenXpert MTB/RIF method.Conclusion The positive detection rate of Mycobacterium tuberculosis by GeneXpert MTB/RIF technique is higher than that of smear and culture method. It has certain clinical application value for early diagnosis of tuberculosis, and its operation is simple and rapid, which is worthy of promotion.

关 键 词：菌阴肺结核 结核分枝杆菌 GeneXpertMTB/RIF技术 

分 类 号：R521[医药卫生—内科学]