支气管肺泡灌洗液RNA恒温扩增检测涂阴肺结核的诊断价值

Clinical value of simultaneous amplification and testing in bronchoalveolar lavage fluid in the diagnosis of smear-negative pulmonary tuberculosis

目的：评价支气管肺泡灌洗液结核分枝杆菌RNA恒温扩增检测（ simultaneous amplification and testing for Mycobacterium tuberculosis, SAT-TB）对涂阴肺结核的诊断价值。方法选取涂阴肺结核组（观察组）95例和非结核病组（对照组）67例共计162例,两组患者均行纤维支气管镜检查,留取支气管肺泡灌洗液行荧光定量PCR（ FQ-PCR）,RNA恒温扩增检测（ SAT-TB）,结核菌快速培养,计算BALF 的SAT-TB对涂阴肺结核诊断的敏感度,特异度,阳性预测值,阴性预测值。结果 SAT-TB检测BALF对诊断涂阴肺结核的敏感度为53．7%,特异度为98．5%,阳性预测值为98．1%,阴性预测值为60．0%,BALF的SAT-TB检测在敏感度,特异度,阳性预测值,阴性预测值与FQ-PCR法相比较均无显著性差异（χ2值分别为3．572,0．341,0．679,1．603,P值均〉0．05）。结论 BALF中SAT-TB检测在涂阴肺结核中的敏感度,特异度均较高,且检测快速,对涂阴肺结核的快速诊断具有较大的应用价值。

Objective To evaluate the value of simultaneous amplification and testing for mycobacteriumtuberculosis （ SAT-TB） in bronchoalveolar lavage fluid （ BALF） in the diagnosis of smear-negative pulmonary tuber-culosis （ PTB） . Methods The study selected 95 cases of active pulmonary tuberculosis as the observation group and 67 cases of non-active pulmonary tuberculosis as the control group. BALF was obtained by brochchoscopy and then tested by FQ-PCR, SAT-TB assay and Bactec MGIT 960 culture. The sensitivity, specificity, PPV and NPV for each diagnostic test were calculated. Results The sensitivity, specificity, positive prediction value, negative prediction value of SAT-TB for smear-negative PTB were 53. 7%, 98. 5%, 98. 1% and 60. 0% respectively. There was no sig-nificantly difference between SAT-TB and FQ-PCR in sensitivity （χ2 =3. 572, P〉0. 05）, specificity （χ2 =0. 341, P〉0. 05）, positive prediction value （χ2 =0. 679, P〉0. 05）, negative prediction value （χ2 =1. 063, P〉0. 05）. Conclusion The sensitivity and specificity of SAT-TB in BALF are very high and the detection time of SAT-TB is very short, which has a good application value for fast diagnosis in smear-negative PTB.