核酸MALDI-TOF MS检测在肺结核诊断中的价值  

Value of nucleic acid MALDI-TOF MS detection in the diagnosis of pulmonary tuberculosis

作　　者：柯晓仙 杨雪[1,2] 黄学 安利峰 杨燕霞[2] Ke Xiaoxian;Yang Xue;Huang Xue;An Lifeng;Yang Yanxia(School of Medicine,Northwest Minzu University,Lanzhou 730000,China;Department of Respiratory and Critical Care Medicine,The Second People's Hospital of Gansu Province,Lanzhou 730000,China;Department of Respiratory and Critical Care Medicine,The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army,Lanzhou 730000,China)

机构地区：[1]西北民族大学医学部,兰州730000 [2]甘肃省第二人民医院呼吸与危重症医学科,兰州730000 [3]中国人民解放军联勤保障部队第九四〇医院呼吸与危重症医学科,兰州730000

出　　处：《保健医学研究与实践》2024年第6期49-54,72,共7页Health Medicine Research and Practice

基　　金：2023年陇原青年创新创业人才(个人)项目(甘组通字〔2023〕20号)。

摘　　要：目的探讨基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)在疑似肺结核(PTB)诊断中的应用价值及其阳性结果的影响因素,以期为临床治疗提供参考。方法选取甘肃省第二人民医院(西北民族大学附属医院)2022年8月—2023年3月收治的疑似PTB患者77例为研究对象。所有患者肺泡灌洗液(BALF)均接受MALDI-TOF MS检测和结核分枝杆菌(MTB)培养。根据MTB培养结果,对核酸MALDI-TOF MS检测进行诊断效能分析,并探讨核酸MALDI-TOF MS检测阳性的影响因素。结果核酸MALDI-TOF MS检测结果显示,MTB阳性共37例(48.1%,37/77),40例阴性(51.9%,40/77)。以培养结果为金标准,核酸MALDI-TOF MS的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和准确度分别为90.9%、84.1%、81.1%、92.5%和87.0%,采用Kappa检验法评价核酸MALDI-TOF MS检测和MTB培养法的一致性,结果显示Kappa值为0.739(P<0.05)。2组患者在是否有糖尿病、身体质量指数(BMI)及降钙素原(PCT)方面比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:有糖尿病和PCT异常为核酸MALDITOF MS阳性的独立危险因素(P<0.05)。结论核酸MALDI-TOF MS检测对PTB的早期诊断具有重要价值,可为患者的规范用药提供更好的指导,即为患者的治疗制定更为精准、有效的治疗方案,从而提高治疗效果、改善患者生活质量。Objective To explore the application value of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS)in the diagnosis of suspected pulmonary tuberculosis(PTB)and the influencing factors of positive results,in order to provide evidence for clinical treatment.Methods Overall,77 patients with suspected PTB admitted to the Second People's Hospital of Gansu Province Affiliated Hospital of Northwest University fo Nationalities from August 2022 to March 2023 were selected as the study subjects.Bronchoalveolar lavage fluid(BALF)samples from all patients were checked and subjected to Mycobacterium tuberculosis(MTB)culture.The diagnostic performance of nucleic acid MALDI-TOF MS detection was analyzed based on the results of MTB culture,and the characteristics of patients with positive nucleic acid MALDI-TOF MS detection were explored.Results According to the nucleic acid MALDI-TOF MS detection 37 cases(48.1%,37/77)were MTB positive,and 40 cases(51.9%,40/77)were negative.Referring to the MTB culture as the gold standard,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of nucleic acid MALDI-TOF MS were 90.9%,84.1%,81.1%,92.5%,and 87.0%,respectively.The Kappa test was used to evaluate the consistency between nucleic acid MALDI-TOF MS detection and MTB culture methods,demonstrating a Kappa value of 0.739(P<0.05).The comparison of patients with and without diabetes,BMI,and abnormal PCT between the two groups showed statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that diabetes and PCT were independent risk factors for positive nucleic acid MALDI-TOF MS detection(P<0.05).Conclusion Nucleic acid MALDI-TOF MS detection has significant value in the early diagnosis of PTB,providing better guidance for standardized medication,which allows for more precise and effective treatment plans,promotes treatment outcomes,and increases patient quality of life.

关 键 词：核酸基质辅助激光解吸电离飞行时间质谱 肺结核 诊断效能 影响因素 

分 类 号：R521[医药卫生—内科学]