三种结核分枝杆菌检测方法在某综合医院的应用价值评估  

Evaluation of the application value of three detection methods for Mycobacterium tuberculosis in a comprehensive hospital

作　　者：顾金花 张盼盼 Gu Jinhua;Zhang Panpan(Department of Laboratory,Kunshan First People's Hospital,Suzhou 215300,China)

机构地区：[1]昆山市第一人民医院检验科,苏州215300

出　　处：《结核与肺部疾病杂志》2025年第1期68-72,共5页Journal of Tuberculosis and Lung Disease

摘　　要：目的:比较传统抗酸染色(简称“抗酸染色”)、BACTEC MGIT 960快速液体培养系统(简称“快速培养”)和Xpert MTB/RIF等3种不同的痰结核分枝杆菌检测方法单一及联合应用在综合医院肺结核诊断中的效能。方法:研究纳入2021年1月至2023年6月在昆山市第一人民医院就诊的652例肺结核患者和166例非结核病患者的临床资料,包括痰液标本检测结果(抗酸染色、快速培养、GeneXpert MTB/RIF)及患者的临床诊断信息。结果:抗酸染色的敏感度为28.8%(188/652),特异度为98.8%(164/166),阳性预测值为98.9%(188/190),阴性预测值为26.1%(164/628),Kappa值为0.136(95%CI:0.109~0.163)。快速培养的敏感度为39.3%(256/652),特异度为98.2%(163/166),阳性预测值为98.8%(256/259),阴性预测值为29.2%(163/559),Kappa值为0.199(95%CI:0.164~0.234)。GeneXpert MTB/RIF检测的敏感度为44.5%(290/652),特异度为99.4%(165/166),阳性预测值为99.7%(290/291),阴性预测值为31.3%(165/527),Kappa值为0.242(95%CI:0.204~0.281)。三种检测方法联合应用的敏感度为53.8%(351/652),特异度为97.6%(162/166),阳性预测值为98.9%(351/355),阴性预测值为35.0%(162/463),Kappa值为0.309(95%CI:0.263~0.354)。结论:相较于单一检测方法,采用3种方法联合检测能够提高肺结核诊断的效能和准确性,可以为综合医院肺结核患者发现提供必要指导。Objective:This study aimed to compare the diagnostic performance of three sputum-based Mycobacterium tuberculosis detection methods:traditional acid-fast staining,the BACTEC MGIT 960 rapid liquid culture system,and Xpert MTB/RIF,as well as their combined application in diagnosing pulmonary tuberculosis in comprehensive hospitals.Methods:The study included clinical data of 652 pulmonary tuberculosis patients and 166 non-tuberculosis patients treated at Kunshan First People’s Hospital between January 2021 and June 2023.Data included sputum specimen testing results(acid-fast staining,rapid culture,and GeneXpert MTB/RIF)and clinical diagnostic information.Results:Acid-fast staining showed a sensitivity of 28.8%(188/652),specificity of 98.8%(164/166),positive predictive value(PPV)of 98.9%(188/190),negative predictive value(NPV)of 26.1%(164/628),and a Kappa value of 0.136(95%CI:0.109-0.163).BACTEC MGIT 960 rapid culture showed a sensitivity of 39.3%(256/652),specificity of 98.2%(163/166),PPV of 98.8%(256/259),NPV of 29.2%(163/559),and a Kappa value of 0.199(95%CI:0.164-0.234).GeneXpert MTB/RIF showed a sensitivity of 44.5%(290/652),specificity of 99.4%(165/166),PPV of 99.7%(290/291),NPV of 31.3%(165/527),and a Kappa value of 0.242(95%CI:0.204-0.281).Combination of the 3 methods achieved a sensitivity of 53.8%(351/652),specificity of 97.6%(162/166),PPV of 98.9%(351/355),NPV of 35.0%(162/463),and a Kappa value of 0.309(95%CI:0.263-0.354).Conclusion:Compared to individual detection methods,the integrated approach combining three testing methods can improve efficacy and accuracy of pulmonary tuberculosis diagnosis,providing important guidance for tuberculosis detection in comprehensive hospitals.

关 键 词：分枝杆菌 结核 染色与标记 培养技术 分子诊断技术 

分 类 号：R521[医药卫生—内科学]