结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测及结核感染T细胞检测在肺结核诊断中的应用价值  

Application value of Xpert MTB/RIF and tuberculosis infection T-cell detection in the diagnosis of pulmonary tuberculosis

作　　者：梅琳 张艳 钟彝蝶 卿斯琪 邓颖 Mei Lin;Zhang Yan;Zhong Yidie;Qing Siqi;Deng Ying(Department of Clinical Laboratory,Jianyang People′s Hospital,Chengdu,Sichuan 641400,China)

机构地区：[1]四川省简阳市人民医院实验医学科,四川成都641400

出　　处：《实用医技杂志》2023年第5期314-317,共4页Journal of Practical Medical Techniques

基　　金：四川省成都市医学科研项目(2022449)。

摘　　要：目的探讨不同检测方法在肺结核诊断中的应用价值。方法回顾性选取2022年1月至12月简阳市人民医院收治的呼吸系统疾病患者272例,依据最终临床诊断分为肺结核组145例,非结核肺病组127例。所有患者均采集痰液、肺泡灌洗液、全血样本,进行涂片抗酸染色、结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测(Xpert MTB/RIF)、外周全血γ-干扰素释放试验检测(TB-IGRA),比较3种方法的诊断价值。结果272例患者中,痰涂片阳性37例(13.6%),Xpert MTB/RIF阳性122例(44.8%),TB-IGRA阳性158例(58.1%)。痰涂片、Xpert MTB/RIF、TB-IGRA检测的敏感度分别是25.5%、82.1%、77.2%;特异度分别是100%,97.6%,63.8%;Kappa系数分别为0.242、0.788、0.413。Xpert MTB/RIF检测中利福平耐药基因突变结果显示,有6例患者利福平耐药,rpoB基因突变主要是ProbeE突变和ProbeA、B联合突变。结论在3种检测方法中,Xpert MTB/RIF检测在诊断肺结核中诊断价值最高,可以为临床提供较好的参考价值。Objective To explore the application value of different diagnostic methods in diagnosing pulmonary tuberculosis.Methods A retrospective analysis was conducted on 272 patients with respiratory system diseases admitted to Jianyang People′s Hospital from January to December 2022.They were divided into two groups:the pulmonary tuberculosis group(145 cases)and the non-tuberculosis lung disease group(127 cases).Sputum,bronchoalveolar lavage fluid,and whole blood samples were collected from all patients for acid-fast staining,tuberculosis mycobacterium/rifampicin resistance real-time fluorescence quantitative nucleic acid amplification test(Xpert MTB/RIF),and peripheral whole-blood gamma interferon release assay(TB-IGRA)to compare the diagnostic value of the three methods.Results Among the 272 patients,sputum smear showed a total of 37 positive cases(13.6%),Xpert MTB/RIF detected a total of 122 positive cases(44.8%),and TB-IGRA detected a total of 158 positive cases(58.1%).The sensitivity of sputum smear,Xpert MTB/RIF,and TB-IGRA was 25.5%,82.1%,and 77.2%,respectively.The specificity was 100%,97.6%,and 63.8%,respectively.The Kappa coefficients were 0.242,0.788,and 0.413,respectively.Among the positive cases detected by Xpert MTB/RIF,six patients had mutations in the rifampicin resistance gene,with mutations occurring at ProbeE and combined mutations at ProbeA and ProbeB.Conclusion Among the three diagnostic methods,Xpert MTB/RIF exhibits the highest comprehensive diagnostic value in diagnosing pulmonary tuberculosis and can provide a good reference value for clinical practice.

关 键 词：干扰素γ释放试验 结核分枝杆菌涂片 核酸扩增技术 结核 肺 

分 类 号：R521[医药卫生—内科学]