不同检测方法在结核性脑膜炎诊断中的应用价值

Study on application value of different methods in diagnosis of tuberculous meningitis

搜集陕西省结核病防治院2015年5月至2017年5月疑似结核性脑膜炎的住院患者519例,最终根据2010年国际结核性脑膜炎协作组制定的诊断标准,354例被诊断为结核性脑膜炎,其余165例排除结核性胸膜炎的诊断。评价BACTEC MGIT 960液体快速培养(简称“MGIT 960培养”)、RNA恒温扩增实时荧光检测技术(SAT-TB技术)、聚合酶链式反应-荧光探针检测技术(简称“PCR技术”)、GeneXpert MTB/RIF(简称“GeneXpert”)技术对结核性脑膜炎的诊断价值。MGIT 960培养、SAT-TB技术、PCR技术、GeneXpert技术检测结核性脑膜炎的敏感度及其95%CI值分别为23.7%(84/354;19.5%~28.4%)、7.6%(27/354;5.2%~10.7%)、12.4%(44/354;9.3%~16.2%)、39.5%(140/354;34.6%~44.7%),特异度分别为100.0%(165/165)、100.0%(165/165)、100.0%(165/165)、99.4%(164/165)。GeneXpert技术检测的敏感度明显高于MGIT 960培养、SAT-TB和PCR技术。

The related information and data were collected from 519 patients who hospitalized at Shaanxi Provincial Tuberculosis Hospital from May 2015 to May 2017 and were suspected to have tuberculous meningitis. According to the Diagnostic Criteria for Tuberculous Meningitis which was developed by the International Collaborative Group on Tuberculous Meningitis in 2010, 354 cases were finally diagnosed as tuberculous meningitis while 165 cases were excluded. This study evaluated the value of different diagnostic techniques as follows in diagnosis of tuberculous meningitis: BACTEC MGIT 960 (MGIT 960) rapid liquid culture, RNA simultaneous amplification and testing (SAT-TB), polymerase chain reaction-fluorescence probe (PCR), and GeneXpert MTB/RIF (GeneXpert). The sensitivity of MGIT 960 rapid liquid culture, SAT, PCR-fluorescence probe and GeneXpert MTB/RIF in tuberculous meningitis diagnosis were 23.7%(84/354;19.5%-28.4%), 7.6%(27/354;5.2%-10.7%), 12.4%(44/354;9.3%-16.2%) and 39.5%(140/354;34.6%-44.7%) respectively;the specificity of those four techniques were 100.0%(165/165), 100.0%(165/165), 100.0%(165/165) and 99.4%(164/165), respectively. The sensitivity of GeneXpert MTB/RIF in tuberculous meningitis diagnosis was much higher than that of MGIT 960, SAT-TB and PCR-fluorescence probe.