GeneXpert MTB/RIF、MTB-PCR、SAT-TB检测BALF在涂阴肺结核的诊断价值及卫生经济学评价  

The diagnostic value and health economic evaluation of BALF detected by GeneXpert MTB/RIF,MTB-PCR,SAT-TB in smear negative pulmonary tuberculosis

作　　者：井晓婷 周忠 秦万 高莹 汪雪 JING Xiao-Ting;ZHOU Zhong;QIN Wan;GAO Ying;WANG Xue(Guiyang Public Health Clinical Center,Guiyang 550004,China;Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵阳市公共卫生救治中心,贵阳550004 [2]贵州医科大学,贵阳550004

出　　处：《实验室检测》2024年第8期8-13,共6页Laboratory Testing

基　　金：贵阳市科技计划项目(2022-4-9-2)

摘　　要：目的 比较结核分枝杆菌及利福平耐药快速检测技术(XpertMTB/RIF)、分枝杆菌核酸PCR-荧光探针检测(MTB-NTM-PCR)、RNA恒温扩增实时荧光检测(SAT-TB)检测支气管肺泡灌洗液(BALF)在涂阴肺结核的诊断价值及卫生经济学价值。方法 回顾性分析2019年1月至2022年7月在贵阳市公共卫生救治中心收治的100例临床确诊肺结核但痰涂片阴性的患者,所有患者连续3次痰涂片阴性,且均在本院纤维支气管镜室进行纤维支气管镜检查,BALF标本同时采用涂片抗酸染色、GeneXpert MTB/RIF、MTB-PCR和SAT-TB检测方法进行检测,以最终临床诊断肺结核为金标准,计算三种方法的诊断效率及进行成本—效果分析。结果 100例涂阴肺结核患者BALF样本XpertMTB/RIF、MTB-PCR、SAT-TB的阳性率分别为53.00%、43.00%、35.00%;以临床诊断作为金标准,XpertMTB/RIF(χ^(2)=21.459,P<0.001)、MTB-PCR(χ^(2)=17.695,P<0.001)、SAT-TB(χ^(2)=12.631,P<0.001)和临床诊断的阳性率差异均有统计学意义;XpertMTB/RIF、MTB-PCR、SAT-TB、XpertMTB/RIF+MTB-PCR、XpertMTB/RIF+SAT-TB、MTB-PCR+SAT-TB和三者联合检测的灵敏度分别为64.20%、53.09%、43.21%、67.90%、66.67%、58.02%、69.14%;特异性分别为94.74%、100.00%、100.00%、94.74%、94.74%、100.00%、94.74%;经ROC分析显示,XpertMTB/RIF、MTB-PCR、SAT-TB、XpertMTB/RIF+MTB-PCR、XpertMTB/RIF+SAT-TB、MTBPCR+SAT-TB及三者联合检测的AUC分别为0.795、0.765、0.716、0.813、0.807、0.790、0.819。结论 在对涂阴肺结核快速检测时,不提倡在诊治之初时同时选择上述三种检查。从成本效果上考虑,MTB-PCR可作为涂阴肺结核诊断的优选检查方式。Objective To compare the diagnostic value and health economic value of rapid detection of mycobacterium tuberculosis and rifampicin resistance(XpertMTB/RIF),mycobacterium nucleic acid PCR-fluorescent probe detection(MTB-NTM-PCR)and RNA isothermal amplification real-time fluorescence detection(SAT-TB)in detecting bronchial alveolar lavage fluid(BALF)in smear-negative pulmonary tuberculosis Be worth.Methods A retrospective analysis was conducted on 100 patients with clinically diagnosed pulmonary tuberculosis but negative sputum smears admitted to Guiyang Public Health Treatment Center from January 2019 to July 2022.All patients had negative sputum smears for three consecutive times and underwent fiberoptic bronchoscopy in the fiberoptic bronchoscopy room of our hospital.BALF specimens were simultaneously tested by smear acid-fast staining,GeneXpert MTB/RIF,MTB-PCR and SAT-TB detection methods.Taking the final clinical diagnosis of pulmonary tuberculosis as the gold standard,the diagnostic efficiency of the three methods and cost-effectiveness analysis were calculated.Results The positive rates of XpertMTB/RIF,MTB-PCR and SAT-TB in 100 BALF samples were 53.00%,43.00%and 35.00%,respectively.Taking clinical diagnosis as the gold standard,the positive rates of XpertMTB/RIF(χ^(2)=21.459,P<0.001),MTB-PCR(χ^(2)=17.695,P<0.001),SAT-TB(χ^(2)=12.631,P<0.001)and clinical diagnosis were statistically significant.The sensitivity of XpertMTB/RIF,MTB-PCR,SAT-TB,XpertMTB/RIF+MTB-PCR,XpertMTB/RIF+SAT-TB,MTB-PCR+SAT-TB and the three combined detections were 64.20%,53.09%,43.21%and 67,respectively 90%,66.67%,58.02%,69.14%;The specificity was 94.74%,100.00%,100.00%,94.74%,94.74%,100.00%,94.74%,respectively.ROC analysis showed that The AUC of XpertMTB/RIF,MTB-PCR,SAT-TB,XpertMTB/RIF+MTBPCR,XpertMTB/RIF+SAT-TB,MTB-PCR+SAT-TB and the combined detection were 0.795,0.765,0.716 and 0.813,respectively 0.807,0.790,0.819.Conclusion In the rapid detection of negative tuberculosis,it is not recommended to select the above three tests at the

关 键 词：BALF XpertMTB/RIF MTB-PCR SAT-TB 涂阴肺结核 成本—效果 

分 类 号：R521[医药卫生—内科学]