肺结核新型诊断技术研究与评价  

Research and Evaluation of New Diagnostic Technologies for Pulmonary Tuberculosis

作　　者：彭磊 周敏 张翠 刘丹 尹琼 Peng Lei;Zhou Min;Zhang Cui;Liu Dan;Yin Qiong(Xinyu People’s Hospital,Xinyu Jiangxi 338000)

机构地区：[1]新余市人民医院,江西新余338000

出　　处：《国外医药（抗生素分册）》2024年第5期342-346,共5页World Notes on Antibiotics

基　　金：新余市科技计划项目(20203090865)。

摘　　要：目的探讨实时荧光定量核酸扩增检测(Xpert)和结核分枝杆菌(MTB)/利福平(RIF)检测诊断肺结核的价值。方法选择2021年1月—2023年7月新余市人民医院接诊的疑似肺结核患者164例,均接受痰涂片镜检、Xpert&MTB/RIF检测,以结核分枝杆菌培养作为金标准,对比两种检测方式诊断肺结核的价值及与临床诊断的一致性,并对比两种检测方式的检查所需时间。结果164例疑似肺结核患者,经临床确诊为肺结核84例(51.22%),非肺结核80例(48.78%)。Xpert&MTB/RIF对肺结核诊断的阴性预测值为72.73%、特异度为100.00%(80/80)、灵敏度为64.29%(54/84)、准确度为81.71%(134/164)、阳性预测值为100.00%(54/54),均高于痰涂片镜检,有统计学差异(P<0.05);Xpert&MTB/RIF诊断结果与临床诊断结果一致性尚可(kappa=0.637,P<0.05);痰涂片镜检诊断结果与临床诊断结果一致性不佳(kappa=0.278,P<0.05);Xpert&MTB/RIF检查所需时间短于痰涂片镜检,有统计学差异(P<0.05)。结论Xpert&MTB/RIF诊断效能优于痰涂片镜检,且检查所需时间较短,利于临床早期制定治疗方案。Objective To investigate the value of real-time fluorescence quantitative nucleic acid amplification test(xpert)-Mycobacterium tuberculosis(MTB)/rifampicin(RIF)in the diagnosis of pulmonary tuberculosis.Methods A total of 164 patients with suspected pulmonary tuberculosis admitted to Xinyu People’s Hospital from January 2021 to July 2023 were selected.All patients underwent sputum smear microscopy and Xpert&MTB/RIF detection.Mycobacterium tuberculosis culture was used as the gold standard.A comparison was made between the two detection technologies'usefulness in diagnosing pulmonary tuberculosis,as well as their consistency with clinical diagnosis and time requirements.Results Among 164 suspected pulmonary tuberculosis patients,84 cases(51.22%)were clinically diagnosed as pulmonary tuberculosis,and 80 cases(48.78%)were non-pulmonary tuberculosis.The negative predictive value of Xpert&MTB/RIF for the diagnosis of pulmonary tuberculosis was 72.73%,the specificity was 100.00%(80/80),the sensitivity was 64.29%(54/84),the accuracy was 81.71%(134/164),and the positive predictive value was 100.00%(54/54),which were higher than those of sputum smear microscopy,with statistical differences(P<0.05);The findings of Xpert&mtb/rif testing agreed with the clinical diagnosis(kappa=0.637,P<0.05).There was insufficient agreement between the results of sputum smear microscopic diagnosis and the clinical diagnosis(kappa=0.278,P<0.05);there was a statistically significant difference in the time required for Xpert&mtb/rif testing and sputum smear microscopy(P<0.05).Conclusion The diagnostic efficacy of Xpert&MTB/RIF is better than that of sputum smear microscopy,and the examination time is shorter,which is conducive to early clinical treatment.

关 键 词：肺结核 痰涂片镜检 结核分枝杆菌培养 Xpert&MTB/RIF 一致性 

分 类 号：R978[医药卫生—药品]