支气管内超声引导下经支气管针吸活检联合Xpert MTB/RIF对胸内淋巴结结核的诊断价值及影响因素分析  

Diagnostic value and influencing factors of endobronchial ultrasound-guided transbronchial needle aspiration combined with Xpert MTB/RIF for intrathoracic lymph node tuberculosis

作　　者：齐齐 蔡青山[2] 邹兴武[2] 胡钦[2] 周建英[1] Qi Qi;Cai Qingshan;Zou Xingwu;Hu Qin;Zhou Jianying(Department of Respiratory and Critical Care Medicine,First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310003,China;Zhejiang Tuberculosis Diagnosis and Treatment Center,Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院呼吸与危重症医学科,杭州310003 [2]浙江省中西医结合医院结核病诊疗中心,杭州310003

出　　处：《中华结核和呼吸杂志》2024年第8期754-760,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：浙江省医药卫生科技计划(2022KY984);杭州市医药卫生科技项目(A20200475)。

摘　　要：目的评估支气管内超声引导下经支气管针吸活检(EBUS-TBNA)穿刺获取胸内淋巴结样本联合应用利福平耐药实时荧光定量核酸扩增检测(Xpert MTB/RIF,Xpert)用于诊断胸内淋巴结结核的敏感度,并分析其影响因素。方法收集2018年3月至2021年6月在浙江省中西医结合医院疑似胸内淋巴结结核并行EBUS-TBNA的患者106例[男55例,女51例,年龄(45.1±18.6)岁],包括后续诊断为胸内淋巴结结核患者64例,非结核病患者42例。纳入患者的胸内淋巴结穿刺样本开展Xpert检测和传统病原学检测,分析不同检测方法及不同方法组合的阳性结果,并采用单因素和多因素logistic回归分析Xpert独立检测阳性的影响因素。结果Xpert的敏感度为65.6%(95%CI:52.7%~77.1%),特异度为97.6%(95%CI:87.4%~99.9%),阳性预测值为97.7%(95%CI:85.7%~99.7%),阴性预测值为65.1%(95%CI:57.0%~72.4%)。Xpert单独检测的阳性率(65.6%,42/64)与MGIT960、组织病理学和Xpert联合检测阳性率(70.3%,45/64)比较差异无统计学意义(P=0.570)。多因素logistic回归分析发现病变淋巴结位于纵隔(OR=5.84,95%CI:1.11~30.70,P=0.037)、淋巴结内出现坏死(OR=6.32,95%CI:1.46~27.38,P=0.014)、淋巴结轴向深度≥17 mm(OR=6.61,95%CI:1.41~30.97,P=0.017)是Xpert检测阳性的促进因素。结论EBUS-TBNA联合Xpert检测对胸内淋巴结结核具有较高的临床诊断价值,当穿刺样本较少时,可优选Xpert检测。穿刺时选取病变位于纵隔、淋巴结内出现坏死、淋巴结轴向深度≥17 mm的淋巴结进行穿刺可提高Xpert检测阳性率。ObjectiveTo evaluate the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)puncture to obtain intrathoracic lymph node samples combined with Xpert MTB/RIF(Xpert)detection for the diagnosis of intrathoracic lymph node tuberculosis.MethodsFrom March 2018 to June 2021,106 patients[55 males and 51 females,age(45.1±18.6)years]with suspected intrathoracic lymph node tuberculosis and EBUS-TBNA were collected in Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine,including 64 patients with subsequent diagnosis of intrathoracic lymph node tuberculosis and 42 patients without tuberculosis.Xpert test and traditional etiology test were performed on the patients′intrathoracic lymph node puncture specimens.The positive results of different detection methods and different methods were analyzed,and the influencing factors of Xpert independent detection positive were analyzed by univariate and multivariate logistic regression.ResultsThe sensitivity of Xpert was 65.6%(95%CI:52.7%-77.1%),the specificity was 97.6%(95%CI:87.4%-99.9%),the positive predictive value was 97.7%(95%CI:85.7%-99.7%),the negative predictive value was 65.1%(95%CI:57.0%-72.4%).The positive rate of Xpert alone(65.6%,42/64)was not significantly different from that of MGIT960,histopathology and Xpert combined detection(70.3%,45/64)(P<0.05).Multivariate logistic regression analysis showed that the location of the diseased lymph nodes in the mediastinum(OR=5.84,95%CI:1.112-30.704,P=0.037),necrosis in the lymph nodes(OR=6.32,95%CI:1.460-27.384,P=0.014),and the axial depth of the lymph nodes≥17 mm(OR=6.61,95%CI:1.408-30.969,P=0.017)were the promoting factors for the positive Xpert test.ConclusionsEBUS-TBNA combined with Xpert detection has a high clinical diagnostic value for intrathoracic lymph node tuberculosis.When the number of puncture samples is small,Xpert detection can be preferred.The positive rate of Xpert detection can be improved by selecting lymph nodes with mediastinal lesions,lymph nodes

关 键 词：结核 淋巴结 支气管镜 活组织检查 针吸 影响因素 

分 类 号：R522[医药卫生—内科学]