肺泡灌洗液结核杆菌RNA、T-SPOT在菌阴肺结核诊断中的应用  

Application of Alveolar Lavage Tuberculosis RNA,T-SPOT in the Diagnosis of Pulmonary Tuberculosis

作　　者：张帆 林健 林芬 ZHANG Fan;LIN Jian;LIN Fen(Department of Respiratory Tuberculosis,Fuzhou Pulmonary Hospital,Fujian Province,Fuzhou Fujian 350000,China)

机构地区：[1]福建省福州肺科医院呼吸结核科,福建福州350000

出　　处：《中国卫生标准管理》2023年第23期18-22,共5页China Health Standard Management

摘　　要：目的探讨肺泡灌洗液结核杆菌RNA和X-pert方法,培养、涂片检查及结核感染T细胞斑点试验(T cell spot test,T-SPOT)在菌阴肺结核诊断中的价值,并筛选出最佳的检测方法组合。方法收集2022年7月1日—2022年9月26日确诊肺结核病例患者134例。对所有患者进行肺泡灌洗液结核杆菌RNA和X-pert方法,培养、涂片检查及T-SPOT等11种检测方案,并分析其在菌阴肺结核患者诊断中的阳性率、阳性预测值、阴性预测值等指标,以及各种检测方法之间的一致性。结果根据数据统计分析,T-SPOT具有最高的阳性率(82.8%)和较低的阴性预测值(17.1%),可以有效地识别出菌阴肺结核患者,但也存在较高的误诊风险。X-pert方法和菌种鉴定方法的阳性率相同(56.7%),但X-pert方法的阳性预测值和阴性预测值都比菌种鉴定方法略高一些(56.7%vs.47.0%和43.2%∶52.9%),说明X-pert方法在区分患者和非患者方面略优于菌种鉴定方法。T-SPOT、X-pert是菌阴肺结核诊断中最佳的2种检测方法,可作为诊断菌阴肺结核的重要手段。结论T-SPOT、X-pert是菌阴肺结核诊断中最佳的2种检测方法,可作为诊断菌阴肺结核的重要手段,而其他检测方法的价值相对较低,需与其他方法联合使用。Objective To explore the value of mycobacterium tuberculosis RNA,X-pert,smear examination and T cell spot test(T-SPOT)test in the diagnosis of bacteria negative pulmonary tuberculosis in alveolar lavage fluid,and to screen the best combination of detection methods.Methods A total of 134 cases of pulmonary tuberculosis confirmed from July 1,2022 to September 26,2022 were collected.All patients were tested with 11 detection schemes,including alveolar lavage fluid mycobacterium tuberculosis RNA,X-pert,smear examination and T-SPOT,and their positive rate,positive predictive value,negative predictive value and other indicators in the diagnosis of bacteria negative pulmonary tuberculosis patients were analyzed,as well as the consistency between various detection methods.Results According to data statistical analysis,T-SPOT had the highest positive rate(82.8%)and a lower negative predictive value(17.1%),which could effectively identify patients with bacterial negative pulmonary tuberculosis,but there was also a high risk of misdiagnosis.The positive rates of the X-pert method and the bacterial identification method were the same(56.7%),but the positive and negative predictive values of the X-pert method were slightly higher than those of the bacterial identification method(56.7%vs.47.0%and 43.2%vs.52.9%),indicating that the X-pert method was slightly better than the bacterial identification method in distinguishing patients and non patients.T-SPOT and X-pert were the two best detection methods in the diagnosis of bacterial negative pulmonary tuberculosis,and could be used as important means for diagnosing bacterial negative pulmonary tuberculosis.Conclusion T-SPOT and X-pert are the two best detection methods in the diagnosis of bacterial negative pulmonary tuberculosis,and can be used as important means for diagnosing bacterial negative pulmonary tuberculosis.However,other detection methods have relatively low value and need to be used in combination with other methods.

关 键 词：菌阴肺结核 肺泡灌洗液 结核杆菌RNA T细胞斑点试验 X-pert 菌种鉴定 

分 类 号：R521[医药卫生—内科学]