Xpert MTB/RIF在诊断结核病中的临床应用评价

Clinical Evaluation of Xpert MTB/RIF in the Diagnosis of Pulmonary Tuberculosis

目的探讨Xpert MTB/RIF检测技术对诊断肺结核的临床应用价值。方法收集506例疑似结核病患者的样本,通过与结核菌培养,抗酸杆菌显微镜检测,及临床诊断相比较来评价Xpert MTB/RIF试验的诊断效能。结果79.4%(402/506)的患者被临床诊断为结核病,其中肺结核为315例,肺外结核为87例。Xpert MTB/RIF、结核菌培养、抗酸杆菌显微镜检测及3种方法相结合诊断,在肺结核患者的检出率分别是52.4%(165/315)、49.5%(156/315)、36.8%(116/315)和57.1%(180/315);在肺外结核患者的检出率分别为13.8%(12/87)、18.4%(16/87)、3.4%(3/87)和25.3%(22/87);Xpert MTB/RIF试验在诊断肺结核以及肺外结核的特异性均为100%。结论对于肺结核的诊断,Xpert MTB/RIF与结核诊断金标准分枝杆菌培养有着很高的阳性一致率,且特异性更好,但是对于肺外结核的诊断,其敏感性较差,3种方法相结合比单独一种方法能获得更好的敏感度,更有利于临床的诊治。

Objective To explore the clinical application value of Xpert MTB/RIF detection technology in the diagnosis of pulmonary tuberculosis.Methods A sample of 506 tuberculosis patients was collected and evaluated for sensitivity and specificity of Xpert MTB/RIF assays by comparison with tuberculosis culture,acid-fast bacilli microscopy,and clinical diagnosis.Results 79.4%(402/506)of patients were clinically diagnosed with tuberculosis,including 315 cases of tuberculosis and 87 cases of extrapulmonary tuberculosis.Xpert MTB/RIF,tuberculosis culture,acidfast bacilli microscopic examination and combined diagnosis of three methods,the detection rate in tuberculosis patients were 52.4%(165/315),49.5%(156/315),36.8%(116/315)and 57.1%(180/315);the detection rates of extrapulmonary tuberculosis patients were 13.8%(12/87),18.4%(16/87),3.4%(3/87)and 25.3%(22/87)respectively;Xpert MTB/RIF test is 100% specific in the diagnosis of tuberculosis and extrapulmonary tuberculosis.Conclusion For the diagnosis of tuberculosis,the Xpert MTB/RIF test has better sensitivity than Mtb culture,but it is less sensitive to the diagnosis of extrapulmonary tuberculosis.The combination of the three methods gives better sensitivity than the single method.The combination of Xpert MTB/RIF detection technology and solid culture method is more conducive to clinical diagnosis and treatment.