Gene MTB/RIF、TB-IGRA检测与传统组织病理学检查在脊柱结核诊断中的应用价值  

Application value of Gene MTB/RIF,TB-IGRA and traditional histopathology in the diagnosis of spinal tuberculosis

作　　者：杨增敏[1] 芮敏劼 嵇辉[1] 张国英[2] 洪练青[3] 黄振超[1] 陈其义[1] 陈林萍 YANG Zengmin;RUI Minjie;JI Hui(The Second Department of Orthopedics,Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing,210014,China)

机构地区：[1]南京中医药大学附属南京市中西医结合医院骨二科,南京市210014 [2]南京中医药大学附属南京市中西医结合医院检验科,南京市210014 [3]南京中医药大学附属南京市中西医结合医院病理科,南京市210014 [4]南京中医药大学附属南京市中西医结合医院医院感染管理科,南京市210014

出　　处：《中国脊柱脊髓杂志》2022年第1期50-55,共6页Chinese Journal of Spine and Spinal Cord

基　　金：南京市卫计委重点项目课题(编号:201405050);南京市名中医工作室(陈其义)(宁卫中医[2014]11号)。

摘　　要：目的:评估传统组织病理学(简称“病理”)检查与Gene MTB/RIF(简称“Xpert”)、γ干扰素释放试验(TB-IGRA)在脊柱结核诊断中的应用价值。方法:回顾性分析2017年11月~2020年6月在我院经临床诊断为“脊柱结核”的131例患者资料,男79例,女52例;年龄18~90岁(50±18.0岁);颈椎7例,胸椎39例,胸腰段11例,腰椎57例,腰骶椎12例,骶椎5例。所有患者术前进行TB-IGRA检测,然后通过穿刺或手术获得病灶组织,分别进行病理检查与Xpert检测。病理检查结果分四类:Ⅰ类为确诊结核、Ⅱ类为倾向于结核,Ⅲ类为疑诊结核,Ⅳ类为未确诊结核。Ⅰ类、Ⅱ类病理结果支持脊柱结核诊断,Ⅲ类、Ⅳ类不支持脊柱结核诊断。计算三者的阳性率与阴性率。以病理检查为参照标准,计算Xpert、TB-IGRA的敏感度、特异度,三者单独检测的阳性率、联合检测的阳性率分别进行比较,计算Kappa值评估两者的一致性,并绘制Xpert、TB-IGRA检测的受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积(area under curve,AUC),评估Xpert、TB-IGRA检测的价值。结果:所有患者中,病理确诊为结核85例(64.9%,95%CI为56.6%~73.2%),病理未确诊结核46例(35.1%,95%CI为26.8%~43.4%);Xpert检测阳性79例(60.3%,95%CI为51.0%~68.1%),阴性52例(39.7%,95%CI为31.9%~49%),发现RNA聚合酶β亚基的编码基因(rpoB)突变6例(4.6%,95%CI为0.95%~8.20%);TB-IGRA检测阳性99例(75.6%,95%CI为68.1%.83.0%),阴性32例(24.4%,95%CI为17.0%~31.9%)。病理检查与Xpert检测联合诊断脊柱结核89例(67.9%,95%CI为59.02%~75.32%),未确诊结核42例(32.1%,95%CI为24.68%~40.98%)。病理检查与TB-IGRA检测联合诊断脊柱结核107例(81.7%,95%CI为74.97%~88.39%),未确诊结核24例(18.3%,95%CI为11.61%~25.03%)。Xpert检测敏感度为87.1%(74/85),特异度为91.3%(42/46);TB-IGR检测敏感度为90.6%(77/85),特异度为52.2%(24/46)。病理检查与Xpert检测联合诊断脊柱结核的阳性率为67.9%(89/131);Objectives:To evaluate the value of traditional histopathology,Gene Xpert MTB/RIF(Xpert)and interferon-gamma release assay for mycobacterium tuberculosis(TB-IGRA)in the diagnosis of spinal tuberculosis.Methods:The data of 131 patients diagnosed as"spinal tuberculosis"in our hospital from November 2017 to June 2020 were analyzed retrospectively.Among the 131 patients,79(60.3%)were males and 52(39.7%)were females;aged 18 to 90 years(50.0±18.0 years old).The locations of the disease:39 cases of thoracic vertebrae,57 cases of lumbar vertebrae,12 cases of lumbosacral vertebrae,11 cases of thoracolumbar segment,7 cases of cervical vertebrae and 5 cases of sacral vertebrae.All patients were tested for TB-IGRA before operation,and then the lesion tissues were obtained by puncture or operation.Histopathological examination and Xpert test were carried out respectively,and the positive and negative rates were calculated.Histopathological diagnosis was divided into four categories:categoryⅠwas confirmed tuberculosis,categoryⅡwas inclined to tuberculosis,categoryⅢwas suspected tuberculosis and categoryⅣwas undiagnosed tuberculosis.CategoriesⅠandⅡsupported the diagnosis of spinal tuberculosis,whileⅢandⅣdidn′t support.With histopathological diagnosis as the gold standard,the sensitivity and specificity of Xpert and TB-IGRA examination were obtained and the Kappa value was calculated to evaluate their consistency.The positive rates of single detection and combined detection were compared respectively.The receiver operating characteristic(ROC)curve of Xpert and TB-IGRA was drawn and the area under curve(AUC)was calculated to evaluate the value of Xpert and TB-IGRA.Results:Among the 131 patients,85 were diagnosed with confirmed TB by histopathology(64.9%,95%CI:56.6%-73.2%),46 were undiagnosed TB by histopathology(35.1%,95%CI:26.8%-43.4%),Xpert was positive in 79 cases(60.3%,95%CI:51.0%-68.1%),and negative in 52 cases(39.7%,95%CI:31.9%-49%),rpoB mutations were found in 6 cases(4.6%,95%CI 0.95%-8.20%),and TB-IGRA

关 键 词：脊柱结核 诊断 组织病理检查 GENE MTB/RIF检测 Γ干扰素释放试验 

分 类 号：R529.2[医药卫生—内科学] R446.8[医药卫生—临床医学]