Xpert Mtb/RIF检测对肺结核诊断的价值探讨  

To explore the clinical value of the diagnosis of tuberculosis by the Xpert Mtb/RIF testing

作　　者：肖传宇[1] 侯文华[1] 郭传龙 Xiao Chuanyu;Hou WenHua;Guo Chuanlong(Department of Laboratory,the first people's Hospital in zaoyang of Hubei city,zaoyang 441200,China)

机构地区：[1]枣阳市第一人民医院检验科,湖北枣阳441200

出　　处：《现代科学仪器》2021年第5期157-160,223,共5页Modern Scientific Instruments

摘　　要：目的:探究结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF,XMR)在快速诊断肺结核(Tuberculosis,TB)及利福平(RIF)耐药的临床应用价值。方法:选取我院2019年1月至12月收治住院的347例疑似TB患者为研究对象,收集到197份痰液标本,105份肺泡灌洗液标本和45份胸水标本。进行抗酸染色涂片法、MGIT液体培养法(简称"液培法")及XMR检测,分别以液培法和药敏法为金标准,分析XMR检测结核分枝杆菌(MTB)和RIF耐药的效能,比较不同方法检测Mtb和RIF耐药的阳性检出率。结果:XMR检测MTB的灵敏度(81.09%)和阴性预测值(73.05%)均高于抗酸染色涂片法(31.84%,49.63%),比较差异有统计学意义(X^(2)=51.247,102.354,P<0.05)。特异性(70.55%)、阳性预测值(79.13%)低于抗酸染色涂片法(92.47%,85.33%),比较差异有统计学意义(X^(2)=30.214,53.274,P<0.05)。XMR检测MTB的kappa值为0.74,与液培法检测MTB一致性良好。XMR检测RIF耐药的灵敏度100.0%、特异性96.92%、阳性预测值93.44%和阴性预测值100.0%。XMR检测RIF的kappa值为0.89,与药敏法检测RIF耐药性具有高度一致性。XMR检测诊断MTB的阳性检出率(59.37%)高于抗酸染色涂片法(21.61%),比较差异有统计学意义(X^(2)=63.287,P<0.05),高于液培法的阳性检出率(57.93%),比较差异无统计学意义(X^(2)=0.274,P>0.05)。液培法的阳性检出率高于抗酸染色涂片法,比较差异有统计学意义(X^(2)=41.027,P<0.05)。XMR和比例药敏法检测RIF的阳性检出率,分别为32.62%、30.48%,两者比较差异无统计学意义(X^(2)=0.341,P>0.05)。结论:XMR检测与抗酸染色涂片镜检、液培法等传统方法相比,对TB诊断具有高灵敏度,高特异度、可快速检测RIF耐药性等优点,有效提高TB阳性检出率,能为TB的临床早期诊断及制定治疗方案提供有效指导依据。objective:To explore the clinical value of real-time fluorescent quantitative nucleic acid amplification(Xpert MTB/RIF,XMR)for the rapid diagnosis of pulmonary tuberculosis(Tuberculosis TB)and rifampicin(RIF)resistance.Methods:Total of 347 suspected TB patients admitted to our hospital from January to December 2019 were selected as the study subjects,and 197 sputum specimens,105 alveolar lavage fluid specimens and 45 pleural effusion specimens were collected.The anti-acid staining smear method,MGIT liquid culture method("liquid culture method")and XMR test were carried out.The efficacy of liquid culture method and drug sensitivity method were analyzed XMR detected Mycobacterium tuberculosis(MTB)and RIF of Mycobacterium tuberculosis(MTB)and RIF.Results:The sensitivity(81.09%)and negative predictive value(73.05%)of XMR detection MTB were higher than that of acid-fast staining smear(31.84%,49.63%),The difference was statistically significant(X^(2)=51.247,102.354,P<0.05).specificity(70.55%),positive predictive value(79.13%)was lower than that of acidfast staining smear(92.47%,85.33%),The difference was statistically significant(X^(2)=30.214,53.274,P<0.05).The kappa value of XMR detection MTB is 0.74,which is in good agreement with liquid culture method.The sensitivity of XMR detection RIF drug resistance was 100.0%,specificity 96.92%,positive predictive value 93.44%and negative predictive value 100.0%respectively.The kappa value of XMR detection RIF is 0.89,High consistency with drug sensitivity test RIF drug resistance.The positive rate of XMR diagnostic MTB(59.37%)was higher than that of acid-fast staining smear(21.61%),The difference was statistically significant(X^(2)=63.287,P<0.05),Higher than the positive rate of liquid culture(57.93%),The difference was statistically significant(X^(2)=41.027,P<0.05).The positive rates of XMR and proportional susceptibility test RIF were 32.62%and 30.48%,between the two(X^(2)=0.341,P>0.05).Conclusion:XMR detection has the advantages of high sensitivity,high specificity,rapid de

关 键 词：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 肺结核 痰液标本 抗酸染色涂片法 药敏法 

分 类 号：R52[医药卫生—内科学]