利福平耐药实时荧光定量核酸扩增技术联合结核感染T淋巴细胞酶联免疫斑点试验诊断结核性脑膜炎的价值  

Diagnostic value of rifampin resistance real-time fluorescent quantitative nucleic acid amplification technology combined with T cell spot test of tuberculosis infection in tuberculous meningitis

作　　者：陈宇 姚素艳[1] Chen Yu;Yao Suyan(School of Basic Medicine,Jinzhou Medical University,Jinzhou 121000,China;Department of Tuberculosis,Chest Hospital,Shenyang Tenth People′s Hospital,Shenyang 110044,China)

机构地区：[1]锦州医科大学基础医学院,121000 [2]沈阳市第十人民医院(沈阳市胸科医院)结核科,110044

出　　处：《中国医师进修杂志》2021年第3期264-268,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的评价利福平耐药实时荧光定量核酸扩增技术(GeneXpert)联合结核感染T淋巴细胞酶联免疫斑点试验(T-SPOT.TB)诊断结核性脑膜炎(TBM)的价值。方法回顾性分析2017年3月至2019年12月沈阳市胸科医院70例TBM患者(TBM组)和30例非TBM患者(非TBM组)的临床资料。患者均行GeneXpert和T-SPOT.TB检测。以脑脊液MGIT960液体培养结果作为金标准,评估GeneXpert和T-SPOT.TB诊断TBM的情况。结果TBM组GeneXpert、T-SPOT.TB、两种方法并联及两种方法串联的阳性率均明显高于非TBM组[27.14%(19/70)比0、72.86%(51/70)比46.67%(14/30)、78.57%(55/70)比46.67%(14/30)和21.43%(15/70)比0],差异有统计学意义(P<0.01或<0.05)。两种方法并联诊断TBM的灵敏度最高为78.57%,准确度达71.00%;而两种方法串联诊断TBM的特异度为100.00%,误诊率为0。结论GeneXpert和T-SPOT.TB两种方法并联诊断TBM的灵敏度最高,两种方法串联及GeneXpert单独检测的特异度均高达100.00%,两种方法串联可降低TBM的误诊率,并联可降低漏诊率。Objective To evaluate the diagnostic value of rifampin resistance real-time fluorescent quantitative nucleic acid amplification technology(GeneXpert)combined with T cell spot test of tuberculosis infection(T-SPOT.TB)in tuberculous meningitis(TBM).Methods The clinical data of 70 TBM patients(TBM group)and 30 non-TBM patients(non-TBM group)in Shenyang Chest Hospital from March 2017 to December 2019 were retrospectively analyzed.All patients were detected by GeneXpert and T-SPOT.TB.The results of MGIT960 liquid culture of cerebrospinal fluid were used as the gold standard to evaluate the diagnosis of TBM by GeneXpert and T-SPOT.TB.Results The positive rates of GeneXpert and T-SPOT.TB in parallel and in series in TBM group were significantly higher than those in non-TBM group:27.14%(19/70)vs.0,72.86%(51/70)vs.46.67%(14/30),78.57%(55/70)vs.46.67%(14/30)and 21.43%(15/70)vs.0,and there were statistical differences(P<0.01 or<0.05).The sensitivity and accuracy of two methods in parallel in TBM diagnosis were 78.57%and 71.00%respectively.The specificity and misdiagnosis rate of two methods in series in TBM diagnosis were 100.00%and 0 respectively.Conclusions The sensitivity of GeneXpert and T-SPOT.TB in parallel is the highest in TBM diagnosis.The specificity of the two methods in series and GeneXpert alone is as high as 100.00%.The two methods can reduce the misdiagnosis rate of TBM in series and reduce the rate of missed diagnosis in parallel.

关 键 词：结核 脑膜 诊断 核酸扩增技术 酶联免疫斑点检测 

分 类 号：R529.3[医药卫生—内科学]