超声、CT引导下经皮穿刺联合Xpert MTB/RIF技术早期诊断脊柱结核的价值

Ultrasound and CT Guided Percutaneous Puncture Combined with Xpert MTB/RIF Technology for Early Diagnosis of Spinal Tuberculosis

目的探讨超声、CT引导下经皮穿刺微创技术联合Xpert MTB/RIF技术早期诊断脊柱结核的临床应用价值。方法选取2018年1月~2019年12月在新疆维吾尔自治区胸科医院骨科接受超声、CT引导下经皮穿刺的疑似脊柱结核患者67例,穿刺获取的病灶标本同时采用Xpert MTB/RIF、BACTEC MGIT 960和抗酸染色技术进行结果对比。以临床综合诊断为参照标准,评价Xpert MTB/RIF技术对脊柱结核的诊断效能。结果以临床综合诊断为参照标准,67例疑似患者中确诊为脊柱结核患者43例,非脊柱结核24例。三种检测方法报告时间比较:抗酸染色为(3.67±1.72)h,Xpert技术为(1.00±0.40)d,BACTEC MGIT960法结核菌培养为(10.40±2.90)d。抗酸染色、结核菌培养及Xpert技术诊断脊柱结核的敏感度和特异度分别为34.88%和100.00%,48.84%和95.83%,81.40%和95.83%;一致性分析显示:Xpert技术一致性较好(Kappa=0.73),抗酸染色(Kappa=0.28)和结核菌培养(Kappa=0.37)一致性一般。三种检测方法对脊柱结核的诊断价值为Xpert技术(AUC值=0.89)>结核菌培养(AUC值=0.72)>抗酸染色(AUC值=0.67)。结论经超声、CT引导下的经皮穿刺术具有早期、微创、安全的优势,联合Xpert技术对脊柱结核的早期准确诊断具有较高的价值。

Objective To explore the clinical application value of ultrasound and CT guided percutaneous puncture minimally invasive technique combined with Xpert MTB/RIF technique for early diagnosis of spinal tuberculosis.Methods 67 patients with suspected spinal tuberculosis underwent ultrasound and CT guided percutaneous puncture in the Department of Orthopedics,Chest Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019,the specimens obtained by puncture were compared with Xpert MTB/RIF,BACTEC MGIT 960 and acid-fast staining technique.Using the comprehensive clinical diagnosis as the reference standard,the diagnostic efficacy of Xpert MTB/RIF technology for spinal tuberculosis was evaluated.Results Taking the comprehensive clinical diagnosis as the reference standard,of the 67 suspected patients,43 were diagnosed with spinal tuberculosis and 24 were non-spine tuberculosis.Comparison of the reporting time of the three detection methods:acid-fast staining is(3.67±1.72)h,Xpert technique is(1.00±0.40)d,BACTEC MGIT 960 method tuberculosis culture is(10.40±2.90)d The sensitivity and specificity of acid-fast staining,tuberculosis culture and Xpert technology for the diagnosis of spinal tuberculosis were 34.88%and 100.00%,48.84%and 95.83%,81.40%and 95.83%,respectively.Consistency analysis showed that Xpert technology had good consistency(Kappa=0.73),acid-fast staining(Kappa=0.28)and tuberculosis culture(Kappa=0.37)were generally consistent.The diagnostic value of the three detection methods for spinal tuberculosis is Xpert technique(AUC value=0.89)>tuberculosis culture(AUC value=0.72)>acid-fast staining(AUC value=0.67).Conclusion Ultrasound and CT-guided percutaneous puncture has the advantages of early,minimally invasive and safe.Combined with Xpert technology,it has high value for the early and accurate diagnosis of spinal tuberculosis.