TB-RNA、TB-DNA、基因芯片技术检测BALF对儿童涂阴肺结核的早期诊断价值  

The value of detecting BALF by TB-RNA,TB-DNA and gene chip technology in the early diagnosis of smear-negative pulmonary tuberculosis in children

作　　者：严红梅 阮琰 陈晓红 毛文捷 陈芬 YAN Hongmei;RUAN Yan;CHEN Xiaohong;MAO Wenjie;CHEN Fen(Department of Pediatrics,Fuzhou Pulmonary Hospital of Fujian Province,Fuzhou,Fujian 350000,China;Department of Tuberculosis,Fuzhou Pulmonary Hospital of Fujian Province,Fuzhou,Fujian 350000,China;Department of Clinical Laboratory,Fuzhou Pulmonary Hospital of Fujian Province,Fuzhou,Fujian 350000,China)

机构地区：[1]福州肺科医院儿科,福建福州350000 [2]福州肺科医院结核科,福建福州350000 [3]福州肺科医院检验科,福建福州350000

出　　处：《临床肺科杂志》2023年第9期1345-1351,共7页Journal of Clinical Pulmonary Medicine

摘　　要：目的评估结核菌核糖核酸(tuberculosis bacterium ribonucleic acid,TB-RNA)、结核菌脱氧核糖核酸(tuberculosis bacterium deoxyribonucleic acid,TB-DNA)、基因芯片技术检测支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)对儿童涂阴肺结核的早期诊断价值。方法收集2019年1月至2022年8月于福建省福州肺科医院住院的227例0~17岁疑似涂阴肺结核患儿的BALF,进行TB-RNA、TB-DNA、基因芯片检测,分析三种检测方法的诊断效能。结果诊断为肺结核168例,非肺结核59例。以临床综合诊断(composite reference standard,CRS)为金标准,三种方法单独检测及联合检测BALF的敏感度分别为40.48%、39.29%、38.69%、56.55%,特异度分别为98.31%、96.61%、100%、94.92%,曲线下面积(Area under the curve,AUC)分别为0.694、0.679、0.693、0.757,单独检测的敏感度与培养法(44.64%)比较,差异均无统计学意义(χ^(2)分别为1.24,1.73,2.53,P均>0.05),联合检测的敏感度高于培养法及单独检测,差异均有统计学意义(χ^(2)分别为9.52,25.04,27.03,28.03,P均<0.05);三种方法检测的敏感度BALF明显高于痰,差异均有统计学意义(χ^(2)分别为41.33,24.92,28.17,P均<0.05)。以培养结果阳性为金标准,BALF进行三种方法单独检测及联合检测的敏感度分别为76.00%、69.33%、72%、85.33%,特异度分别为98.31%、96.61%、100%、94.92%,阳性预测值(Positive predictive value,PPV)分别为98.28%、96.30%、100%、95.52%,阴性预测值(Negative predictive value,NPV)分别为76.32%、71.25%、73.75%、83.58%,Kappa值分别为0.72、0.64、0.69、0.79,AUC分别为0.872、0.830、0.860、0.901。结论TB-RNA、TB-DNA、基因芯片检测BALF可快速诊断涂阴肺结核,联合检测可以提高儿童涂阴肺结核的病原学诊断率。Objective To evaluate the early diagnostic value of detection of bronchoalveolar lavage fluid(BALF)by tuberculosis bacterium ribonucleic acid(TB-RNA),tuberculosis bacterium deoxyribonucleic acid(TB-DNA),and gene chip technology for smear-negative pulmonary tuberculosis in children.Methods From January 2019 to August 2022,227 children aged 0 to 17 years old with suspected negative smear pulmonary tuberculosis were collected from Fuzhou Pulmonary Hospital in Fujian Province,and TB-RNA,TB-DNA and gene chip detection were performed to analyze the diagnostic efficiency of the three detection methods.Results There were 168 cases of pulmonary tuberculosis and 59 cases of non-pulmonary tuberculosis.Using composite reference standard(CRS)as the gold standard,the sensitivity of BALF detected by three methods alone and in combination was 40.48%,39.29%,38.69%and 56.55%,respectively.the specificity was 98.31%,96.61%,100%and 94.92%,and the Area under the curve(AUC)was 0.694,0.679,0.693 and 0.757,respectively.The sensitivity of single detection was compared with that of culture method(44.64%).There was no significant difference(χ^(2):1.24,1.73,2.53,P>0.05),and the sensitivity of combined detection was higher than that of culture method and single detection,with statistical significance(χ^(2):9.52,25.04,27.03,28.03,P<0.05).The sensitivity of BALF detected by the three methods was significantly higher than that of sputum,and the difference was statistically significant(χ^(2):41.33,24.92,28.17,P<0.05).With positive culture results as the gold standard,the sensitivity and specificity of BALF were 76.00%,69.33%,72%,and 85.33%,respectively,and 98.31%,96.61%,100%,and 94.92%,respectively.Positive predictive value(PPV)was 98.28%,96.30%,100%,and 95.52%,respectively.Negative predictive value(NPV)was 76.32%,71.25%,73.75%,83.58%,and Kappa value was 0.72,0.64,0.69,0.79,respectively.AUC was 0.872,0.830,0.860,and 0.901,respectively.Conclusion The detection of BALF using TB-RNA,TB-DNA and gene chip can quickly diagnose smear-negative pulmona

关 键 词：结核菌核糖核酸 结核菌脱氧核糖核酸 基因芯片 支气管肺泡灌洗液 肺结核 儿童 

分 类 号：R529.9[医药卫生—内科学]