粪便GeneXpert MTB/RIF检测在肠结核诊断中的应用价值  

Diagnostic application of GeneXpert MTB/RIF in stool specimens for intestinal tuberculosis

作　　者：刘荣梅[1] 吕子征 马丽萍[2] 李强[1] 宋艳华[1] 陈红梅[1] 孔忠顺[1] 高孟秋[1] Liu Rongmei;Lyu Zizheng;Ma Liping;Li Qiang;Song Yanhua;Chen Hongmei;Kong Zhongshun;Gao Mengqiu(DepartmentⅡof Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;DepartmentⅠof Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核二科,北京101149 [2]首都医科大学附属北京胸科医院结核一科,北京101149

出　　处：《中国防痨杂志》2023年第2期139-143,共5页Chinese Journal of Antituberculosis

基　　金：北京市通州区高层次人才发展支持计划领军人才(YHLJ202010);北京市属医院科研培育计划(PX2019060);首都卫生发展科研专项(首发2022-2-1041)。

摘　　要：目的:评价对粪便标本进行利福平耐药实时荧光定量核酸扩增(GeneXpert MTB/RIF)检测诊断肠结核的临床应用价值。方法:收集2019年1月至2021年12月首都医科大学附属北京胸科医院就诊的538例临床疑似肠结核患者的粪便标本,进行荧光涂片显微镜镜检、BACTEC MGIT 960液体快速培养、GeneXpert MTB/RIF检测,同时行全血结核感染T细胞斑点试验、肠镜及肠黏膜组织病理检查,分析粪便标本通过GeneXpert MTB/RIF方法诊断肠结核的效能。结果:538例疑似肠结核患者经临床诊断标准诊断,其中189例诊断为肠结核,349例诊断为非肠结核(包括溃疡型结肠炎、肠道感染、消化道溃疡、恶性肿瘤、克罗恩病等)。以临床诊断结果为标准,粪便标本GeneXpert MTB/RIF检测的敏感度和特异度分别为77.2%(95%CI:70.5%~82.9%)和51.0%(95%CI:45.6%~56.3%),粪便荧光涂片显微镜镜检的敏感度和特异度分别为23.3%(95%CI:17.6%~30.1%)和92.8%(95%CI:89.5%~95.2%);粪便BACTEC MGIT 960液体快速培养的敏感度和特异度分别为29.1%(95%CI:22.9%~36.2%)和83.7%(95%CI:79.3%~87.3%)。结论:对粪便标本进行GeneXpert MTB/RIF检测诊断肠结核的敏感度较高,可用于细菌学诊断证据缺乏的临床诊断患者,以提高肠结核的诊断水平。Objective:To evaluate the diagnostic value of rifampicin resistance real-time fluorescence quantitative nucleic acid amplification assay(GeneXpert MTB/RIF)in testing stool specimens for detecting intestinal tuberculosis.Methods:From January 2019 to December 2021,the stool samples of 538 patients with clinically suspected intestinal tuberculosis were collected from Beijing Chest Hospital,Capital Medical University.Fluorescent smear microscopy,BACTEC MGIT 960 liquid rapid growth culture,GeneXpert MTB/RIF detection were performed.At the same time,the whole blood T-cell spot test,enteroscopy and intestinal mucosal tissue pathology were performed to analyze the diagnostic efficacy of fecal samples in diagnosing intestinal tuberculosis by GeneXpert MTB/RIF.Results:Out of 538 patients suspected of intestinal tuberculosis,189 were diagnosed as intestinal tuberculosis according to clinical diagnostic criteria,349 were diagnosed as non intestinal tuberculosis(including ulcerative colitis,intestinal infection,gastrointestinal ulcer,malignant tumor,Crohn’s disease,etc.).With the clinical diagnostic criteria as the gold standard,the sensitivity and specificity of GeneXpert MTB/RIF test on stool samples were 77.2%(95%CI:70.5%-82.9%)and 51.0%(95%CI:45.6%-56.3%),respectively;The sensitivity and specificity of stool fluorescent smear microscopy were 23.3%(95%CI:17.6%-30.1%)and 92.8%(95%CI:89.5%-95.2%);The sensitivity and specificity of fecal liquid rapid growth culture were 29.1%(95%CI:22.9%-36.2%)and 83.7%(95%CI:79.3%-87.3%).Conclusion:In the diagnosis of intestinal tuberculosis,stool GeneXpert MTB/RIF test showed relatively high sensitivity for detecting Mycobacterium tuberculosis in clinical diagnosed patients who lack bacteriological diagnosis evidence,which could improve the diagnosis level of intestinal tuberculosis.

关 键 词：结核 胃肠 粪便 分子诊断技术 敏感性与特异性 

分 类 号：R524[医药卫生—内科学] R8[医药卫生—临床医学]