Gene Xpert在肺外结核病临床诊断中的价值探讨

Discussion on the value of Gene Xpert in the clinical diagnosis of extrapulmonary tuberculosis

目的对比Gene Xpert检测、结核杆菌感染T细胞斑点试验(T-SPOT.TB)及培养法这3种检测在肺外结核病诊断中的应用效能,旨在为疾病的诊断提供参考。方法选取无锡市第五人民医院2019年10月-2021年3月接诊的214例疑似肺外结核患者为研究对象,所有入选患者均进行Gene Xpert检测、T-SPOT.TB及培养法,比较Gene Xpert检测、T-SPOT.TB及培养法这3种检测的诊断结果,并分析3种检测的灵敏度、特异度、准确度、阳性预测值、阴性预测值。结果214例疑似病例中,经临床诊断最终确诊肺外结核144例,非结核70例;灵敏度比较:T-SPOT.TB(86.11%)>Gene Xpert检测(59.72%)>培养法(17.36%),差异有统计学意义(χ^(2)=139.655,P<0.05);特异度比较:Gene Xpert检测(100.00%)>培养法(98.57%)>T-SPOT.TB(92.86%),差异有统计学意义(χ^(2)=7.206,P<0.05);准确度比较:T-SPOT.TB(88.32%)>Gene Xpert检测(72.90%)>培养法(43.93%),差异有统计学意义(χ^(2)=100.554,P<0.05);阴性预测值比较:T-SPOT.TB(76.47%)>Gene Xpert检测(54.69%)>培养法(36.70%),差异有统计学意义(χ^(2)=38.136,P<0.05);三种检测阳性预测值比较差异无统计学意义(P>0.05)。结论Gene Xpert检测在肺外结核病的检测中灵敏度和准确度不及T-SPOT.TB,但特异度具有很大的优势,同时Gene Xpert检测灵敏度、特异度、准确度均高于传统的培养法,在临床中能够对肺外结核病行快速诊断,具有良好的临床诊断价值。

Objective To compare the efficacy of Gene Xpert,T-cell spot of tuberculosis(T-SPOT.TB)and culture method in the diagnosis of extrapulmonary tuberculosis,and provide reference for the diagnosis of the disease.Methods A total of 214 patients with suspected extrapulmonary tuberculosis admitted to the Fifth People's Hospital of Wuxi from October 2019 to March 2021 were selected as the study subjects.All the selected patients underwent Gene Xpert test,T-SPOT.TB test and culture method.The diagnostic results of Gene Xpert test,T-SPOT.TB test and culture method were compared,and the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the three tests were analyzed.Results Among 214 suspected cases,144 cases were diagnosed as extrapulmonary tuberculosis and 70 cases as non-tuberculosis.Sensitivity comparison:T-SPOT.TB(86.11%)>Gene Xpert(59.72%)>culture method(17.36%),the difference was statistically significant(χ^(2)=139.655,P<0.05);specificity comparison:Gene Xpert(100.00%)>culture method(98.57%)>T-SPOT.TB(92.86%),the difference was statistically significant(χ^(2)=7.206,P<0.05);accuracy comparison:T-SPOT.TB(88.32%)>Gene Xpert(72.90%)>culture method(43.93%),the difference was statistically significant(χ^(2)=100.554,P<0.05);negative predictive value comparison:T-SPOT.TB(76.47%)>Gene Xpert(54.69%)>culture method(36.70%),the difference was statistically significant(χ^(2)=38.136,P<0.05).There was no significant difference in the positive predictive values of the three tests(P>0.05).Conclusions The sensitivity and accuracy of Gene Xpert in the detection of extrapulmonary tuberculosis were lower than those of T-SPOT.TB,but its specificity had great advantages.Meanwhile,the sensitivity,specificity and accuracy of Gene Xpert were all higher than those of traditional culture method,which could make rapid diagnosis of extrapulmonary tuberculosis in clinical practice and had good clinical diagnostic value.