三种检测技术在矽肺合并肺结核患者诊断中的应用价值  

Diagnostic value of three detection techniques in patients with silicosis complicated with pulmonary tuberculosis

作　　者：林卫佳 魏艳召 苏菁[1] 陈丽萍[1] 刘建华[1] 赵建清[1] 苑程 LIN Wei-jia;WEI Yan-zhao;SU Jing;CHEN Li-ping;LIU Jian-hua;ZHAO Jian-qing;YUAN Cheng(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院呼吸与危重症医学科,河北张家口075000 [2]张家口市传染病医院

出　　处：《工业卫生与职业病》2023年第1期22-25,65,共5页Industrial Health and Occupational Diseases

基　　金：河北省医学科学研究重点课题计划(20180869)。

摘　　要：目的探讨利福平耐药实时荧光定量核酸扩增检测技术(GeneXpert)、γ-干扰素释放检测技术(TB-IGRA)、结核抗体检测技术(TB-Ab)在矽肺合并肺结核患者的诊断中的应用价值,分析其诊断效能。方法收集2018年1月到2020年12月期间本院收治的308例矽肺患者的资料进行回顾性调查,按照是否并发肺结核分为矽肺合并肺结核组(88例)和矽肺未并发肺结核组(220例)。分析矽肺合并肺结核组患者和矽肺未并发肺结核组患者的一般资料,比较GeneXpert、TB-IGRA、TB-Ab三种检测技术在矽肺合并肺结核组患者和矽肺未并发肺结核组患者间的阳性检出率的差异,分析其诊断效能。结果矽肺壹期并发肺结核、矽肺贰期并发肺结核、矽肺叁期并发肺结核的检出率分别为27.1%、30.7%、35.7%。应用Gen⁃eXpert检测技术检出矽肺并发肺结核患者阳性率为81.8%,TB-IGRA为65.9%,TB-Ab为50.0%,差异有统计学意义(χ^(2)=23.256,P<0.05)。GeneXpert检出矽肺未并发肺结核的假阳性率为13.6%,TBIGRA为27.3%,TB-Ab为36.4%,差异有统计学意义(χ^(2)=28.766,P<0.05)。三者联合检测的的灵敏度、特异度、准确性、阳性预测值、阴性预测值、约登指数可达到90.9%、85.0%、86.7%、70.8%、95.9%、75.9%。GeneXpert检测技术检出矽肺3个期别并发肺结核患者的阳性率明显高于TB-IGRA和TB-Ab的检测结果,TB-IGRA检出阳性率高于TB-Ab检测结果,差异有统计学意义(χ^(2)=32.3,P<0.05)。矽肺合并肺结核组患者的罗氏比例法药敏试验和GeneXpert检测技术检测的结果一致,一致率为88.9%。结论GeneXpert检测技术检出的矽肺合并肺结核患者的阳性率较高,联合TB-Ab、TB-IGRA检测可进一步提高诊断效能,对患者辅助诊断具有较好的应用价值。Objective To investigate the application value of real-time fluorescent quantitative nucleic acid amplification(GeneXpert),interferon gamma release(TB-IGRA)and tuberculosis antibody detection(TB-Ab)in the diagnosis of silicosis complicated with pulmonary tuberculosis.Methods Data of 308 silicosis patients admitted to our hospital from January 2018 to December 2020 were retrospectively investigated,and they were divided into the silicosis group with pulmonary tuberculosis(88 cases)and the silicosis group without pulmonary tuberculosis(220 cases)according to whether they were complicated with pulmonary tuberculosis.The general data of the patients with silicosis complicated with pulmonary tuberculosis and the patients without pulmonary tuberculosis were analyzed.The difference of positive detection rate of GeneXpert,TB-IGRA and TB-Ab in the patients with silicosis complicated with pulmonary tuberculosis and the patients without pulmonary tuberculosis were compared,and their diagnostic efficacy was analyzed The general data of silicosis patients with pulmonary tuberculosis and silicosis patients without pulmonary tuberculosis were analyzed,the difference of positive detection rate of GeneXpert,TB-IGRA,TB-AB three detection techniques in silicosis patients with pulmonary tuberculosis and silicosis patients without pulmonary tuberculosis was compared,and its diagnostic efficacy was analyzed.Results The detection rates of pulmonary tuberculosis in silicosis one stage,pulmonary tuberculosis in silicosis two stage and pulmonary tuberculosis in silicosis three stage were 27.1%,30.7%and 35.7%,respectively.The positive rate of patients with silicosis complicated with pulmonary tuberculosis detected by GeneXpert was 81.8%,65.9%for TB-IGRA and 50.0%for TB-Ab,and the difference was statistically significant(χ~2=23.256,P<0.05).The false positive rate of silicosis without pulmonary tuberculosis detected by GeneXpert was 13.6%,TB-IGRA 27.3%and TB-AB 36.4%,the difference was statistically significant(χ~2=28.766,P<0.05).The sensi

关 键 词：矽肺 肺结核 利福平耐药实时荧光定量核酸扩增技术 γ-干扰素释放检测技术 结核抗体检测技术 

分 类 号：R446[医药卫生—诊断学]