痰涂片、固体培养法、GeneXpert MTB/RIF单独及联合检测结核分枝杆菌能力的比较  

Comparison of sputum smear, solid culture method, and GeneXpert MTB/RIF alone and in combination for the detection of Mycobacterium tuberculosis

作　　者：黄新蕾 陈建保 HUANG Xinlei;CHEN Jianbao(Department of Clinical Laboratory,the People′s Hospital of Jizhou District,Tianjin 301900,China)

机构地区：[1]天津市蓟州区人民医院检验科,天津301900

出　　处：《临床肺科杂志》2025年第1期88-91,125,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的 评估痰涂片、固体培养法、 Gene Xpert MTB/RIF单独及联合检测对结核分枝杆菌的检出能力。方法 选取2019年1月-2024年3月在天津市蓟州区人民医院结核门诊就诊的疑似肺结核的患者568例,满足同时送检痰涂片、固体培养法、GeneXpert MTB/RIF三种检测方法,以临床最终诊断结果为金标准,评价上述三种方法检出结核分枝杆菌的能力。结果 在568例疑似肺结核患者中,临床最终诊断依据《肺结核诊断》(WS 288—2017)[1]标准进行,肺结核患者280例,非结核患者288例。痰涂片、固体培养法、GeneXpert MTB/RIF检测结核分枝杆菌的灵敏度分别为60.4%、84.3%、95.0%,差异具有统计学意义(χ^(2)=109.616,P<0.001),其中GeneXpert MTB/RIF灵敏度最高;三种检测方法特异度比较结果显示,差异无统计学意义(χ^(2)=1.002,P=0.606)。三种方法两两组合检测分析结果显示,痰涂片+固体培养法、痰涂片+GeneXpert MTB/RIF、固体培养法+GeneXpert MTB/RIF灵敏度分别为92.9%、98.2%、99.6%,差异具有统计学意义(χ^(2)=23.893,P<0.001),其中固体培养法+Gene Xpert MTB/RIF组合的灵敏度最高。两种方法联合检测特异度比较结果显示,差异无统计学意义(χ^(2)=0.502,P=0.778)。三种方法联合检测的灵敏度为100%,与金标准相一致;特异度比较结果显示,差异无统计学意义(χ^(2)=2.007,P=0.157)。结论 三种方法联合检测结核分枝杆菌优于单独检测及任意两种方法联合检测,所以建议三种方法同时检测有助于提高结核分枝杆菌的检出率,避免漏诊。Objective To evaluate the ability of sputum smear,solid culture method,and GeneXpert MTB/RIF in the detection of Mycobacterium tuberculosis.Methods A total of 568 patients with suspected pulmonary tuberculosis who were admitted to the People's Hospital of Jizhou District,Tianjin,from January 2019 to March 2024 were selected.Sputum smear,solid culture method,and GeneXpertMTB/RIF were utilized simultaneously in order to detect M.tuberculosis for these M.tuberculosis-confirmed cases.This study compared the detection capability of the three methods above with the final clinical diagnosis serving as the gold standard.Results The final clinical diagnosis was based on the criteria WS 288-201711,among 568 suspected tuberculosis patients,280 tuberculosis patients,and 288 non-tuberculosis patients.The detection sensitivity of sputum smear,solid culture method,and GeneXpert MTB/RIF for M.tuberculosis,was 60.4%,84.3%,and 95.0%,respectively.The difference was statistically significant(x^(2)=109.616,P<0.001),and the GeneXpert MTB/RIF method showed the highest sensitivity.There was no significant difference in the detection specificity of these three methods above(x^(2)=1.002,P=0.606).The detection sensitivity of the pairwise combinations of the above three methods for M.tuberculosis,was 92.9%,98.2%,and 99.6%,respectively.The difference was statistically significant(x^(2)=23.893,P<0.001),and the combination of the Gene Xpert MTB/RIFmethod and solid culture method showed the highest sensitivity.There was no significant difference in the detection specificity of the pairwise combinations of the above three methods(x^(2)=0.502,P=0.778).The sensitivity of the three-method combination was 100%,consistent with the gold standard.There was no significant difference in the detection specificity of the three-method combination and the gold standard(x^(2)=2.007,P=0.157).Conclusion The three-method combination is superior to the single method and the combination of any two methods in the detection of M.tuberculosis,so it is suggested that

关 键 词：结核分枝杆菌 痰涂片 固体培养法 GeneXpert MTB/RIF 

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