不同检测方法在骨结核诊断中的应用效果比较  

Comparison of different detection methods in diagnosis of bone tuberculosis

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

机构地区：[1]沈阳市第十人民医院

出　　处：《中国民康医学》2020年第2期90-92,95,共4页Medical Journal of Chinese People’s Health

摘　　要：目的:比较利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF,简称"Xpert")、荧光PCR熔解曲线法及液体培养方法在骨结核诊断中的应用效果。方法:收集2017年1月至2018年12月期间166例疑似骨结核患者的脓液标本,分别进行分枝杆菌液体培养(MGIT960培养)、Xpert与荧光PCR熔解曲线法检测。以临床综合诊断为标准,对3种检测方法的敏感度和特异度进行比较分析;以液体药敏为金标准,评价Xpert和荧光PCR熔解曲线法检测结核分枝杆菌利福平耐药的敏感度和特异度。结果:Xpert检测的敏感度分别高于荧光PCR熔解曲线法和MGIT960培养法,荧光PCR熔解曲线法的敏感度高于MGIT960培养法,差异有统计学意义(P<0.05);以MGIT960培养为标准,Xpert的敏感度高于荧光PCR熔解曲线法,差异有统计学意义(P<0.05);Xpert与荧光PCR熔解曲线法的特异度比较,差异无统计学意义(P>0.05);以液体药敏为金标准,Xpert和荧光PCR熔解曲线法检测利福平的敏感度和特异度均为80.0%和100%,两种方法与金标准进行一致性检验Kappa值均为0.872。结论:Xpert和荧光PCR熔解曲线法在骨结核诊断中的敏感性和特异度均优于液体培养方法,两种方法各有千秋,可根据实际情况选择。Objective:To compare application effects of Rifampicin-resistant real-time fluorescent quantitative nucleic acid amplification detection technology(Xpert MTB/RIF,"Xpert"for short),fluorescence PCR melting curve method and liquid culture method in diagnosis of bone tuberculosis.Methods:The pus specimens of 166 patients with suspected bone tuberculosis were collected from January 2017 to December 2018,and were tested by Mycobacterial liquid culture(MGIT960 culture),Xpert and fluorescence PCR melting curve methods.Using the clinical comprehensive diagnosis as the criteria,the sensitivity and specificity were compared among the three detection methods.Further,using the liquid sensitivity test as the criteria,the sensitivities and specificities of Xpert and fluorescence PCR melting curve method in the detection of the resistance of Mycobacterium tuberculosis to Rifampicin were evaluated.Results:The sensitivity of Xpert detection was higher than that of the fluorescence PCR melting curve method and the MGIT960 culture method;the sensitivity of the fluorescence PCR melting curve method was higher than that of the MGIT960 culture method;and the differences were statistically significant(P<0.05).Using MGIT960 culture as the standard,the sensitivity of Xpert was higher than the that of fluorescence PCR melting curve method,and the difference was statistically significant(P<0.05).There was no significant difference in the specificity between Xpert and fluorescence PCR melting curve method(P>0.05).Using liquid sensitivity test as the gold standard,the sensitivities and specificities of Xpert and fluorescence PCR melting curve detection for Rifampicin were both 80.0%and 100%,and the Kappa values of consistency test of the two methods with the gold standard were both 0.872.Conclusions:Xpert and fluorescence PCR melting curve method have higher sensitivities and specificities in the detection of bone tuberculosis than liquid culture.Moreover,both methods have their advantages and disadvantages,which should be selected according

关 键 词：骨结核 Xpert MTB/RIF 荧光PCR熔解曲线法 液体培养 

分 类 号：R446.6[医药卫生—诊断学]