痰涂片、TB⁃DNA、Gene Xpert MTB/RIF在肺结核中的阳性检出率对比  

Comparison of positive detection rates of sputum smear,TB⁃DNA,Gene Xpert MTB/RIF in pulmonary tuberculosis

作　　者：王育强[1] 刘送妹 李梅[3] 陈灿华[4] 钟玲 李文根[6] WANG Yuqiang;LIU Songmei;LI Mei;CHEN Canhua;ZHONG Ling;LI Wengen(Department of Infection,Meizhou People's Hospital/Huangtang Hospital,Meizhou,Guangdong,China,514031;Hepatic Department,Meizhou,Guangdong,China,514031;Department of Infection,Hangzhou Xiaoshan District First People's Hospital,Hangzhou,Zhejiang,China,310000;Clinical Laboratory Center,Meizhou,Guangdong,China,514031;Respiratpry Endoscopy Center,Meizhou,Guangdong,China,514031;Rheumatology and Lmmunology Department,Meizhou,Guangdong,China,514031)

机构地区：[1]梅州市人民医院(黄塘医院)感染科,广东梅州514031 [2]梅州市人民医院(黄塘医院)肝病科,广东梅州514031 [3]杭州市萧山区第一人民医院感染科,浙江杭州310000 [4]梅州市人民医院(黄塘医院)临床检验中心,广东梅州514031 [5]梅州市人民医院(黄塘医院)呼吸内镜中心,广东梅州514031 [6]梅州市人民医院(黄塘医院)风湿免疫科,广东梅州514031

出　　处：《分子诊断与治疗杂志》2024年第12期2406-2409,F0003,共5页Journal of Molecular Diagnostics and Therapy

基　　金：广东省医学科学技术研究基金项目(B2022263)。

摘　　要：目的探析对比痰涂片、结核分枝杆菌脱氧核糖核酸(TB⁃DNA)检测、Gene Xpert系统结核分枝杆菌/利福平耐药实时荧光定量基因扩增检测技术(Gene Xpert MTB/RIF)在肺结核中的阳性检出率。方法选择梅州市人民医院感染科2019年1月至2021年12月收治的391例肺结核患者作为观察组,选择同期接受检查的463名健康体检者作为对照组。所有研究对象均接受痰涂片、TB⁃DNA、Gene Xpert MTB/RIF诊断。以结核培养结果为金标准,对比不同诊断技术对非肺结核、肺结核的诊断结果;对比不同诊断技术对肺结核的诊断价值;采用受试者工作特征(ROC)曲线分析痰涂片、TB⁃DNA、Gene Xpert MTB/RIF在肺结核中的阳性检出率。结果不同诊断技术对肺结核的阳性检出率比较差异有统计学意义(P<0.05),且Gene Xpert MTB/RIF阳性检出率(51.52%)高于TB⁃DNA(37.59%)、痰涂片(22.48%)。ROC曲线结果显示,Gene Xpert MTB/RIF诊断肺结核的AUC为0.937(0.919~0.956),高于其余诊断策略(P<0.05);其敏感度、特异度分别为95.9%、91.6%。结论相较于痰涂片、TB⁃DNA诊断技术,Gene Xpert MTB/RIF对于肺结核的阳性检出率更高,与结核培养结果金标准一致性更高。Gene Xpert MTB/RIF诊断效能更优,应根据实践情况灵活选择诊断技术。Objective To explore and compare the positive detection rates of sputum smear,My⁃cobacterium tuberculosis deoxyribonucleic acid(TB⁃DNA)detection,and Gene Xpert real⁃time fluorescence quantitative gene amplification detection technology for Mycobacterium tuberculosis/rifampicin resistance(Gene Xpert MTB/RIF)in pulmonary tuberculosis.Methods A total of 391tuberculosis patients at Meizhou People's Hosppital admitted to the Department of Infectious Diseases from April 2019 to December 2021 were selected as the observation group.Additionally,463 healthy individuals who underwent physical examinations during the same period were chosen as the control group.All study subjects underwent sputum smear,TB⁃DNA,and GeneXpert MTB/RIF diagnosis.The diagnostic results of different diagnostic techniques for non⁃pulmonary tuberculosis and pulmonary tuberculosis were compared using tuberculosis culture as the gold stan⁃dard.The diagnostic value of different diagnostic techniques for pulmonary tuberculosis was also compared.The receiver operating characteristics(ROC)curve was used to analyze the positive detection rate of sputum smear,TB⁃DNA,and GeneXpert MTB/RIF in pulmonary tuberculosis.Results There was a statistically significant difference in the positive detection rate of pulmonary tuberculosis among different diagnostic tech⁃niques(P<0.05).The GeneXpert MTB/RIF positive detection rate(51.52%)was higher than TB⁃DNA(37.59%)and sputum smear(22.48%).The results of the Receiver operating characteristic showed that the AUC of GeneXpert MTB/RIF diagnosis of pulmonary tuberculosis was 0.9937(0.919~0.956),which was higher than other diagnostic strategies(P<0.05).Its sensitivity and specificity are 95.9%and 91.6%,respec⁃tively.Conclusion Compared to sputum smear and TB⁃DNA diagnostic techniques,GeneXpert MTB/RIF has a higher positive detection rate for pulmonary tuberculosis and better consistency with the gold standard of tuberculosis culture diagnosis.GeneXpert MTB/RIF demonstrates superior diagnostic efficacy a

关 键 词：肺结核 GeneXpert 痰涂片 TB⁃DNA 

分 类 号：R521[医药卫生—内科学]