痰涂片镜检、基因芯片技术及GeneXpert MTB/RIF对疑似肺结核患者的检测效能分析  

Performance analysis of sputum smear microscopy,gene chip technology and GeneXpert MTB/RIF in the detection of suspected pulmonary tuberculosis patients

作　　者：孙桂英 倪晓艳 SUN Guiying;NI Xiaoyan(Department of Infection Management,Suzhou Ninth People′s Hospital,Suzhou,Jiangsu 215200,China)

机构地区：[1]苏州市第九人民医院感染管理科,江苏苏州215200

出　　处：《检验医学与临床》2024年第20期3074-3078,共5页Laboratory Medicine and Clinic

基　　金：江苏省苏州市吴江区科教兴卫项目(WWK201608)。

摘　　要：目的分析痰涂片镜检、基因芯片及多色巢式荧光定量聚合酶链反应(GeneXpert MTB/RIF)对疑似肺结核患者的检测效能。方法选取2017年1月至2022年12月该院收治的疑似肺结核患者97例作为研究对象,均实施痰涂片镜检、基因芯片、GeneXpert MTB/RIF及痰液罗氏培养检查。以痰液罗氏培养结果为金标准,探究不同检测方式及联合检测对疑似肺结核的诊断效能,采用Kappa值检验与金标准诊断结果的一致性。结果痰液罗氏培养检测结果显示,97例疑似肺结核患者阳性55例,阴性42例,阳性检出率为56.70%(55/97)。痰液罗氏培养检出非结核分枝杆菌18株,包括鸟分枝杆菌4株,胞内分枝杆菌9株,偶发分枝杆菌1株,堪萨斯分枝杆菌3株,海分枝杆菌1株。痰涂片镜检检出阳性34例,真阳性29例,阳性检出率为35.05%(34/97),基因芯片检出阳性41例,真阳性37例,阳性检出率为42.27%(41/97);GeneXpert MTB/RIF检出阳性44例,真阳性37例,阳性检出率为45.36%(44/97)。基因芯片、GeneXpert MTB/RIF灵敏度、准确率高于痰涂片镜检,基因芯片与GeneXpert MTB/RIF敏感度一致,但基因芯片特异度高于GeneXpert MTB/RIF。非结核分枝杆菌中,痰涂片镜检检出鸟分枝杆菌1株、胞内分枝杆菌2株,基因芯片检出胞内分枝杆菌1株,GeneXpert MTB/RIF检出鸟分枝杆菌1株。痰涂片镜检、基因芯片、GeneXpert MTB/RIF三项联合检出阳性55例,真阳性53例,三项联合检测灵敏度为96.36%(53/55)、特异度为95.24%(40/42)、准确率为95.88%(93/97),均高于单一方法检测的灵敏度与准确率,差异均有统计学意义(P<0.05)。痰涂片镜检与痰液罗氏培养一致性为68.04%(Kappa=0.59);基因芯片与痰液罗氏培养一致性为77.32%(Kappa=0.70);GeneXpert MTB/RIF与痰液罗氏培养一致性为74.23%(Kappa=0.66);三项联合与痰液罗氏培养一致性为95.88%(Kappa=0.89)。结论较GeneXpert MTB/RIF、痰涂片镜检技术,基因芯片诊断效能及一致性更高,且3种Objective To analyze the detection efficiency of sputum smear microscopy,gene chip and multi-color nested fluorescence quantitative polymerase chain reaction(GeneXpert MTB/RIF)in suspected pulmonary tuberculosis patients.Methods A total of 97 patients with suspected pulmonary tuberculosis admitted to the hospital from January 2017 to December 2022 were selected as the research objects.All patients underwent sputum smear microscopy,gene chip,GeneXpert MTB/RIF and L-J culture.The results of L-J culture of sputum were used as the"gold standard"to explore the diagnostic efficacy of different detection methods and combined detection for suspected pulmonary tuberculosis,and Kappa value was used to test the consistency of diagnostic results with the gold standard.Results L-J culture results showed that among 97 suspected pulmonary tuberculosis patients,55 cases were confirmed as positive sputum culture,42 cases were negative sputum culture,and the positive detection rate was 56.70%(55/97).L-J culture of sputum detected 18 strains of non-tuberculous mycobacteria,including 4 strains of Mycobacterium avium,9 strains of Mycobacterium intracellulare,1 strain of Mycobacterium fortuitum,3 strains of Mycobacterium kansasii,and 1 strain of Mycobacterium marinum.Sputum smear microscopy detected 34 positive cases and 29 true positive cases,with a positive detection rate of 35.05%(34/97).Gene chip detected 41 positive cases and 37 true positive cases,with a positive detection rate of 42.27%(41/97).According to GeneXpert MTB/RIF,44 cases were positive and 37 cases were true positive,with a positive detection rate of 45.36%(44/97).The sensitivity and accuracy of gene chip and GeneXpert MTB/RIF were higher than those of sputum smear microscopy.The sensitivity of gene chip and GeneXpert MTB/RIF was the same,but the specificity of gene chip was higher than GeneXpert MTB/RIF.Among the non-tuberculous mycobacteria,1 strain of Mycobacterium avium and 2 strains of Mycobacterium intracellulare were detected by smear microscopy,1 strain of My

关 键 词：痰涂片镜检 基因芯片技术 GeneXpert MTB/RIF 肺结核 检测效能 

分 类 号：R446.5[医药卫生—诊断学] R521.5[医药卫生—临床医学]