经纤维支气管镜不同取材方法联合GeneXpert MTB/RIF对气管支气管结核的诊断价值

Diagnostic value of different sampling methods combined with GeneXpert MTB/RIF for tracheobronchial tuberculosis through fibrobronchoscope

目的探讨经纤维支气管镜不同取材方法联合GeneXpert MTB/RIF对气管支气管结核的诊断价值。方法选取2017年6月至2019年6月徐州医科大学附属徐州市传染病医院收治的达到临床诊断标准的气管支气管结核患者100例。对纤维支气管镜下所见病灶依次行钳夹-刷检方法取材,所有标本均立即送实验室做抗酸染色涂片,其中钳夹标本同时行病理检查、GeneXpert MTB/RIF检测和结核罗氏培养。结果刷检涂片、钳夹涂片、刷检涂片+钳夹涂片、刷检涂片+钳夹涂片+罗氏培养、刷检涂片+钳夹涂片+罗氏培养+病理、GeneXpert MTB/RIF(钳夹组织)、刷检涂片+钳夹涂片+罗氏培养+病理+GeneXpert MTB/RIF检查阳性率分别为23.00%、30.00%、38.00%、51.00%、66.00%、79.00%、88.00%,刷检+钳夹涂片阳性率高于单用刷检涂片、单用钳夹涂片阳性率,差异有统计学意义(χ^2=4.528、3.986,P=0.031、0.042)。刷检涂片+钳夹涂片、刷检涂片+钳夹涂片+罗氏培养、刷检涂片+钳夹涂片+罗氏培养+病理阳性率明显低于GeneXpert MTB/RIF阳性率,差异有统计学意义(χ^2=29.254、18.725、5.024,P=0.000、0.000、0.021)。而全面联合不同取材、检查方法的刷检涂片+钳夹涂片+罗氏培养+病理+GeneXpert MTB/RIF的阳性率又高于GeneXpert MTB/RIF阳性率,差异有统计学意义(χ^2=4.025,P=0.043)。总共检出GeneXpert MTB/RIF阳性79例,其中5例利福平耐药,有3例同时被罗氏培养证实,有1例GeneXpert MTB/RIF利福平耐药,而罗氏培养阴性,未能进一步相互印证,有1例仅GeneXpert MTB/RIF利福平耐药基因检出,而罗氏培养比例法药敏试验结果利福平敏感。结论GeneXpert MTB/RIF检查可早期快速明确结核利福平耐药情况和有效提高气管支气管结核的诊断率,而联合不同取材和检查方法的刷检涂片+钳夹涂片+罗氏培养+病理+GeneXpert MTB/RIF诊断阳性率最高,值得临床推广应用。

Objective To explore the diagnostic value of different sampling methods combined with GeneXpert MTB/RIF through fibrobronchoscope for tracheobronchial tuberculosis.Methods One hundred patients with tracheobronchial tuberculosis who met the clinical diagnostic criteria were selected from June 2017 to June 2019.The lesions seen under fibrobronchoscope were taken by forceps-brush method in turn.All specimens were immediately sent to the examination room for acid-fast stain examination.The forceps specimens were subjected to pathological examination,GeneXpert MTB/RIF detection and tuberculosis Roche culture.Results The positive rates of brush smear,jaw smear,brush smear+jaw smear,brush smear+jaw smear+Roche culture,brush smear+jaw smear+Roche culture+pathology,GeneXpert MTB/RIF(jaw tissue),brush smear+jaw smear+Roche culture+pathology+GeneXpert MTB/RIF were 23.00%,30.00%,38.00%,51.00%,66.00%,79.00%,88.00%respectively.The positive rate of brush+clamp smear was higher than that of brush smear and clamp smear alone,and the difference was statistically significant(χ^2=4.528,3.986,P=0.031,0.042).The positive rates of brush smear+jaw smear,brush smear+jaw smear+Roche culture,brush smear+jaw smear+Roche culture+pathology were significantly lower than those of GeneXpert MTB/RIF,with statistically significant differences(χ^2=29.254,18.725,5.024,P=0.000,0.000,0.021).However,the positive rate of brush smear+clamp smear+Roche culture+pathology+GeneXpert MTB/RIF combined with different materials and examination methods was higher than that of GeneXpert MTB/RIF,and the difference was statistically significant(χ^2=4.025,P=0.043).A total of 79 positive cases of GeneXpert MTB/RIF were detected,including five cases of rifampicin resistance,three cases of which were confirmed by Roche culture at the same time,one case of GeneXpert MTB/RIF rifampicin resistance,while Roche culture was negative,which could not be further verified.One case only detected the gene of GeneXpert MTB/RIF rifampicin resistance,while Roche culture proportion method showed rifampicin sensitivity.Conclusions GeneXpert MTB/RIF examination can quickly identify rifampicin resistance of tuberculosis in early stage and effectively improve the diagnostic rate of tracheobronchial tuberculosis.The positive rate of brush smear+clamp smear+Roche culture+pathology+GeneXpert MTB/RIF diagnosis combined with different materials and examination methods is the highest,which is worthy of clinical promotion and wide application.