以肺泡灌洗液行结核/非结核分枝杆菌检测对菌阴肺结核的诊断价值  

Diagnostic value of pulmonary tuberculosis/non-tuberculous mycobacterium detection in pulmonary alveolar lavage fluid

作　　者：王世艳 赵睿桢 张建勇 赵建军 WANG Shi-Yan;ZHAO Rui-Zhen;ZHANG Jian-Yong(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]遵义医科大学附属医院呼吸与危重症医学科,贵州遵义563000

出　　处：《中国老年学杂志》2024年第4期812-815,共4页Chinese Journal of Gerontology

基　　金：国家自然科学基金资助项目(82060002)。

摘　　要：目的评估取支气管肺泡灌洗液(BALF)进行结核/非结核分枝杆菌(MTB/NTM)检测对菌阴肺结核的诊断价值。方法收集临床诊断为菌阴肺结核的324例患者资料,对上述患者进行支气管镜检查,所有患者取BALF标本,根据检测方法分为MTB/NTM组(进行罗氏培养、涂片抗酸染色、MTB/NTB检测)、利福平耐药实时荧光定量核酸扩增检测技术(GeneXpert MTB/RIF)组(进行罗氏培养、涂片抗酸染色、GeneXpert MTB/RIF检测)、结核分枝杆菌环介导等温扩增技术(TBLAMP)组(进行罗氏培养、涂片抗酸染色、TB-LAMP检测)。结果MTB/NTM组罗氏培养、涂片抗酸染色、MTB/NTM检测阳性率分别为14.04%、1.75%、43.86%;GeneXpert MTB/RIF组罗氏培养、涂片抗酸染色、GeneXpert MTB/RIF检测阳性率分别为16.77%、3.73%、54.66%;TB-LAMP组罗氏培养、涂片抗酸染色、TB-LAMP检测阳性率分别为18.87%、4.72%、49.06%。MTB/NTM、GeneXpert MTB/RIF、TB-LAMP检测分别与罗氏培养、涂片抗酸染色阳性率比较,差异均有统计学意义(P<0.05)。MTB/NTM检测与GeneXpert MTB/RIF检测、TB-LAMP检测比较,差异无统计学意义(χ^(2)=2.185,P=0.335)。结论MTB/NTM检测具有较好诊断效能,相对简单、快捷,相较于TB-LAMP检测、GeneXpert检测更经济,并能鉴别NTM,及时减少NTM病患者误诊后使用结核药引起身体损害及经济损失。Objective To assess the diagnostic value of mycobacterium tuberculosis(MTB)/non-tuberculous mycobacterium(NTM)test by bronchoalveolar lavage fluid(BALF)for smear and culture negative pulmonary tuberculosis.Methods Data were collected from 324 patients clinically diagnosed with smear and culture negative pulmonary tuberculosis,bronchoscopy was performed on all above patients,and BALF specimens were taken.According to the different test method,they were divided into MTB/NTM group(for Lowenstein-Jensen culture,acid-fast staining smear,and MTB/NTM test),GeneXpert MTB/RIF group(for Lowenstein-Jensen culture,acid-fast staining smear,GeneXpert MTB/RIF test),and TB-LAMP group(for Lowenstein-Jensen culture,acid-fast staining smear,and TB-LAMP test).Results The positive rates of Lowenstein-Jensen culture,acid-fast staining smear,and MTB/NTM test in the MTB/NTM group were 14.04%,1.75%,and 43.86%,respectively;the positive rates of Lowenstein-Jensen culture,acid-fast staining smear,and GeneXpert MTB/RIF test in the GeneXpert MTB/RIF group were 16.77%,3.73%,and 54.66%;the positive rates of Lowenstein-Jensen culture,acid-fast staining smear,and TB-LAMP test in the TB-LAMP group were 18.87%,4.72%,and 49.06%,respectively.Positive rates of MTB/NTM,GeneXpert MTB/RIF and TB-LAMP test were significantly different from Lowenstein-Jensen culture,acid-fast staining smear,respectively(P<0.05).Positive rates of MTB/NTM,GeneXpert MTB/RIF and TBLAMP test had no significant difference(χ^(2)=2.185,P=0.335).Conclusions MTB/NTM detection has better diagnostic efficiency,is relatively simple and fast,and is more economical than TB-LAMP and GeneXpert detection.It could also identify NTM,and timely reduce the physical damage and economic loss caused by misdiagnosis and use of tuberculosis drugs in patients with NTM disease.

关 键 词：肺泡灌洗液 菌阴肺结核 结核/非结核分枝杆菌检测 结核分枝杆菌环介导等温扩增技术(TB-LAMP) 利福平耐药实时荧光定量核酸扩增检测技术(GeneXpert MTB/RIF) 

分 类 号：R521[医药卫生—内科学]