利福平耐药实时荧光定量核酸扩增检测技术对涂阴肺结核诊断价值的评价

Evaluation on the diagnostic value of Xpert MTB/RIF test towards smear negative plumonary tuberculosis

目的 探讨利福平耐药实时荧光定量核酸扩增检测技术（Xpert MTB/RIF）对涂阴肺结核诊断的临床价值。方法 选择2014年6-12月株洲市中心医院结核门诊涂阴肺结核病患者131例（涂阴肺结核组）,肺结核确诊患者114例（肺结核确诊组）,其他肺病患者123例（其他肺病组）。对患者进行痰抗酸染色、结核菌素皮肤试验（TST）、痰固体培养和Xpert MTB/RIF检测,分析Xpert MTB/RIF检测的阳性率和特异度,判断其在涂阴肺结核中的诊断价值。结果 Xpert MTB/RIF检测在涂阴肺结核组中阳性率为80.92%（106/131）,在肺结核确诊组中为82.45%（94/114）,在其他肺病组中为0.81%（1/123）,涂阴肺结核组中Xpert MTB/RIF检测阳性率明显高于其他肺病组,差异有高度统计学意义（P〈0.01）;涂阴肺结核中痰培养检测阳性率为71.76%（94/131）,明显低于Xpert MTB/RIF检测阳性率,差异有统计学意义（P〈0.05）。结论 Xpert MTB/RIF检测阳性率和特异性较高,对涂阴肺结核早期诊断有重要的意义。

Objective To explore the clinical value of Xpert MTB/RIF for testing smear negative plumonary tuberculosis（SNPT）. Methods From June to December 2014, 368 cases, including 131 SNPT（SNPT group）, 114 pulmonary tuberculosis（pulmonary tuberculosis group） and 123 other kinds of pulmonary disease（other pulmonary disease group） in Tuberculosis Clinic of Zhuzhou Central Hospital were detected of anti-acid stain test, tuberculin skin test（TST）, sputum culture test and Xpert MTB/RIF. The positive rates and specificity of Xpert MTB/RIF test determining the diagnostic value of SNPT were analyzed. Results The positive rate of Xpert MTB/RIF test was 80.92%（106/131） in SNPT group, 82.45%（94/114） in pulmonary tuberculosis group and 0.81%（1/123） in other pulmonary disease group. The positive rate of Xpert MTB/RIF test in SNPT group was obviously higher than that in other pulmonary disease group, and the difference was statistically significance（P〈 0.01）. The positive rate of sputum culture test in SNPT group was71.76%（94/131）, which was obviously lower than that of Xpert MTB/RIF, and the difference was statistically significance（P〈0.05）. Conclusion The positive rate and specificity of Xpert MTB/RIF test are high, which has important significance on early diagnosis of SNPT.