涂片阳性/Xpert阴性结果早期预测临床标本中存在非结核分枝杆菌的可靠性  

The evaluation of the smear-positive and Xpert-negative outcome as an early indicator of nontuberculous mycobacteria existence in clinical specimen

作　　者：赵悦 王昊然[1] 程美锦 王伟 梁瑞霞[3] 黄海荣[1] Zhao Yue;Wang Haoran;Cheng Meijin;Wang Wei;Liang Ruixia;Huang Hairong(National Clinical Laboratory on Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;The Clinical Laboratory,Henan Provincial Chest Hospital,Zhengzhou 450000,China;The Tuberculosis Department,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]首都医科大学附属北京胸科医院国家结核病临床实验室,北京101149 [2]河南省胸科医院医学检验科,郑州450000 [3]河南省胸科医院结核内科,郑州450000

出　　处：《中国防痨杂志》2025年第1期61-65,共5页Chinese Journal of Antituberculosis

基　　金：国家重点研发计划(2022YFC2305203);北京市卫生健康委员会高层次公共卫生人才(G2023-2-002)。

摘　　要：目的:评估涂片阳性/Xpert阴性结果用于早期预测临床标本中存在非结核分枝杆菌(non-tuberculous mycobacteria,NTM)的可靠性。方法:回顾性分析河南省胸科医院2019年1月至2024年4月新发肺部疾病就诊且涂片显微镜检查报告阳性结果的患者和分离培养鉴定出NTM的患者的实验室检查资料。分析涂片阳性/Xpert阴性结果作为患者分离鉴定出NTM预测指标的准确性。对研究期间培养鉴定为NTM的患者,分析其获得涂片阳性/Xpert阴性结果的比例,了解此预测指标的敏感度;分析涂片阳性的结核病患者中出现Xpert检测阴性结果的比例,了解预测指标的特异度。结果:在纳入的涂片阳性患者中,8.22%(202/2458)的患者同期开展的Xpert检测结果为阴性。在148例涂片阳性/Xpert阴性结果且具有同期培养鉴定结果的患者中,138例(93.24%)培养鉴定出NTM,表明涂片阳性/Xpert阴性结果早期预测临床标本中存在NTM具有良好的准确性。增加γ-干扰素释放试验阴性结果的附加条件后,预测的准确性达到100.00%(73/73),但预测敏感度大幅降低(37.61%,44/117)。在分离鉴定为NTM病的患者中,涂片阳性/Xpert阴性结果预测NTM存在的敏感度为39.78%(109/274),而在涂阳结核病患者中,该指标的特异度为99.56%(2256/2266)。结论:在疑似结核病患者中,涂片阳性/Xpert阴性结果是一项早期、可靠的NTM分离预测指标。Objective:To evaluate the diagnostic reliability of smear-positive/Xpert-negative results as an early predictor for the presence of non-tuberculous mycobacteria(NTM)in clinical specimens.Methods:A retrospective analysis was conducted on laboratory examination data from patients newly diagnosed with pulmonary diseases at Henan Chest Hospital between January 2019 and April 2024.The dataset included cases with positive smear microscopy results and those with NTM confirmed by isolation and culture.The accuracy of smear-positive/Xpert-negative results as a predictive indicator for NTM isolation and identification was assessed.The proportion of patients diagnosed with NTM during the study period who presented smear-positive/Xpert-negative results was analyzed to evaluate the sensitivity of this predictive indicator.Additionally,the proportion of smear-positive tuberculosis patients with negative Xpert test results was examined to determine the specificity of this indicator.Results:Among the smear-positive patients included in the study,8.22%(202/2458)exhibited negative Xpert test results during the same period.Of the 148 patients with smear-positive/Xpert-negative results and concurrent culture-based identification,138 cases(93.24%)were confirmed as NTM through culture,demonstrating the high accuracy of smear-positive/Xpert-negative results as an early predictor for NTM in clinical specimens.When the additional criterion of a negative interferon-gamma release assay(IGRA)result was applied,the predictive accuracy increased to 100.00%(73/73).However,this refinement significantly reduced the sensitivity of the prediction to 37.61%(44/117).The sensitivity of smear-positive/Xpert-negative results in predicting the presence of NTM was 39.78%(109/274)among patients with NTM disease.Conversely,the specificity of this indicator was remarkably high at 99.56%(2256/2266)among patients with smear-positive tuberculosis.Conclusion:In patients suspected of tuberculosis,smear-positive/Xpert-negative results serve as an early and reliab

关 键 词：非典型性细菌 分枝杆菌属 诊断 鉴别 预测 

分 类 号：R378.91[医药卫生—病原生物学] R563[医药卫生—基础医学]