结核分枝杆菌rpoB基因和突变检测对结核性胸膜炎诊断价值研究

Research on the value of Xpert~ MTB/RIF in the diagnosis of pulmonary tuberculosis

目的探讨结核分枝杆菌rpo B基因和突变检测(Xpert~MTB/RIF)在结核性胸膜炎诊断中的临床应用价值。方法选取208例疑似结核性胸膜炎的痰涂片阴性患者,常规进行胸水涂片、胸水固体培养、淋巴细胞百分比、胸水腺苷脱氨酶(ADA)及胸水Xpert~MTB/RIF检测。结果以随访后临床诊断结果为金标准,Xpert~MTB/RIF检测灵敏度显著高于涂片镜检,差异有统计学意义(P<0.01),与固体培养比较差异无统计学意义(P>0.05)。胸水ADA与胸水Xpert~MTB/RIF联合检测,其灵敏度为91.4%,特异度为57.0%,阳性预测值为72.4%,阴性预测值为84.1%。淋巴细胞百分比、胸水ADA与胸水Xpert~MTB/RIF半定量结果ΔCt循环数呈负相关(r值分别为-0.337、-0.249,P<0.05)。胸水涂阳组ΔCt循环数低于胸水涂阴组,胸水菌阳组ΔCt循环数低于胸水菌阴组,差异均有统计学意义(P<0.05)。治疗1个月时,Xpert~MTB/RIF阳性组总有效率明显低于阴性组,差异有统计学意义(P<0.05)。结论 Xpert~MTB/RIF有助于提高结核性胸膜炎检出率,可作为临床重要的辅助鉴别诊断方法。

Objective To explore the clinical value of Xpert~ MTB/RIF in the diagnosis of pulmonary tuberculosis. Methods 208 sputum smear-negative suspected pleural TB patients were selected for smear and solid culture of pleural fluid,and the detection of lymphocyte percentage,adenosine deaminase（ ADA） and Xpert~ MTB/RIF. Results Using clinical diagnosis result as the gold standard after random visit,the sensitivity of Xpert~ MTB/RIF was higher than smear-microscopy,with the difference statistically significant（ P 0. 01）,and there was no statistical significance on the difference compared with the solid culture（ P 0. 05）. The sensitivity and specificity of combined detection（ ADA ＋ Xpert~ MTB/RIF） were respectively 91. 4% and57. 0%,while the positive and negative predictive values were respectively 72. 4% and 84. 1%. There was negative correlation between lymphocyte percentage or ADA with Xpert~ MTB/RIF semi quantitative results ΔCt（ r =-0. 337,-0. 249,P 0. 05）. The cycle threshold was lower in smear positive group than smear negative group,and was lower in culture positive group than culture negative group,with the differences statistically significant（ P 0. 05）. After 1 month therapy,the effectiveness was lower in Xpert~ MTB/RIF positive group than Xpert~ MTB/RIF negative group,with the difference statistically significant（ P 0. 05）. Conclusion Xpert~ MTB/RIF can enhance the detection rate of pulmonary tuberculosis. It could be used as an important auxiliary method for the diagnosis.