5种结核分枝杆菌检测方法的临床应用价值研究

Study on the clinical application value of five detection methods of Mycobacterium tuberculosis

目的评价5种结核分枝杆菌检测方法对肺结核的辅助诊断价值。方法统计2018年1-10月在广州医科大学附属第一医院住院的患者,分为临床诊断肺结核患者和临床诊断非结核普通住院患者共209例,用结核培养法、PCR-荧光探针法、结核感染T淋巴细胞酶联免疫斑点试验(T-SPOT.TB)法、抗酸染色法、利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)法分别进行检测,比较这5种方法在临床诊断中的价值。结果结核培养法、抗酸染色法、PCR-荧光探针法、T-SPOT.TB法、Xpert MTB/RIF法阳性率分别为16.8%、23.4%、39.2%、53.0%、52.2%。结核培养法灵敏度为52.17%,特异度为100.00%;抗酸染色法灵敏度为42.45%,特异度为96.67%;PCR-荧光探针法灵敏度为76.00%,特异度为97.98%;T-SPOT.TB法灵敏度为91.67%,特异度为79.80%;Xpert MTB/RIF法灵敏度为99.09%,特异度为100.00%。结论Xpert MTB/RIF法是最值得推荐的方法,也是唯一可以作为诊断结核感染的分子生物学方法,如果能够联合这几种方法,可以快速、准确地对结核感染进行诊治。

Objective To evaluate the diagnostic value of five Mycobacterium tuberculosis detection methods for tuberculosis.Methods A total of 209 patients who were hospitalized in the First Affiliated Hospital of Guangzhou Medical University from January to October 2018 were divided into 209 clinically diagnosed patients with pulmonary tuberculosis and non-tuberculous patients with clinical diagnosis.The tuberculosis culture method,PCR-fluorescent probe method,tuberculosis infection T lymphocyte enzyme-linked immunospot test(T-SPOT.TB)method,antacid staining method,rifampicin-resistant real-time fluorescent quantitative nucleic acid amplification detection technology(Xpert MTB/RIF)method were separately detected,the value of these 5 methods in clinical diagnosis were compared.Results The positive rates of tuberculosis culture method,antacid staining method,PCR-fluorescent probe method,T-SPOT.TB method,and Xpert MTB/RIF method were 16.8%,23.4%,39.2%,53.0%,and 52.2%,respectively.The sensitivity of the tuberculosis culture method was 52.17%,the specificity was 100.00%;the sensitivity of the acid staining method was 42.45%,the specificity was 96.67%;the sensitivity of the PCR-fluorescent probe method was 76.00%,the specificity was97.98%;and the sensitivity of the T-SPOT.TB method was 91.67%,the specificity was 79.80%;the sensitivity of the Xpert MTB/RIF method was 99.09%,and the specificity was 100.00%.Conclusion The Xpert MTB/RIF method is the most recommended method and the only molecular biological method that can be used to diagnose tuberculosis infection.If these methods can be combined,it can quickly and accurately diagnose and treat tuberculosis infection.