XpertMTB/RIF联合T-SPOT-TB检测对菌阴肺结核的诊断价值

The Diagnostic Value of XpertMTB/RIF Combined with T-SPOT-TB Detection for Bacterial Negative Tuberculosis

目的探讨XpertMTB/RIF联合T-SPOT-TB检测技术对菌阴肺结核的诊断价值。方法方便选取2017年5月—2019年2月间该院收治的怀疑为肺结核、痰涂片阴性的对象276例作为研究对象,均进行Xpert MTB/RIF联合T细胞斑点试验。结果最终确诊菌阴肺结核204例、非结核72例。血清T‐SPOT-TB灵敏度、特异度、阳性预测值、阴性预测值、符合率分别为70.59%、83.33%、92.31%、50.00%、73.91%,Xpert MTB/RIF则为40.68%、100.00%、100.00%、37.30%、56.16%,联合则为80.39%、83.33%、93.18%、60.00%、81.16%。联合诊断灵敏度与阴性预测值、符合率显著高于Xpert MTB/RIF(P<0.05),Xpert MTB/RIF特异度显著高于血清T‐SPOT-TB(P<0.05),血清T‐SPOT-TB阴性预测值低于联合,差异有统计学意义(P<0.05)。结论XpertMTB/RIF联合T-SPOT-TB检测技术是一种简便、快速、准确的方法,且能够提高菌阴(即痰涂阴培阴)肺结核患者发现率及早期诊断率。

Objective To explore the diagnostic value of XpertMTB/RIF combined with T-SPOT-TB detection technology for bacterial negative tuberculosis.Methods From May 2017 to February 2019,276 patients with suspected pulmonary tuberculosis and negative sputum smears who were admitted to the hospital were conveniently selected as the research subjects.All were performed with Xpert MTB/RIF combined T cell spot test.Results 204 cases of bacillary tuberculosis and 72 cases of non-tuberculosis were finally diagnosed.Serum T-SPOT-TB sensitivity,specificity,positive predictive value,negative predictive value,coincidence rate were 70.59%,83.33%,92.31%,50.00%,73.91%,Xpert MTB/RIF was 40.68%,100.00%,100.00%,37.30%,56.16%,the joint is 80.39%,83.33%,93.18%,60.00%,81.16%.The combined diagnostic sensitivity,negative predictive value,and coincidence rate were significantly higher than Xpert MTB/RIF(P<0.05),and the specificity of Xpert MTB/RIF was significantly higher than serum T-SPOT-TB(P<0.05),The negative predictive value of serum T-SPOT-TB was lower than the combination(P<0.05),the difference was statistically significant(P<0.05).Conclusion XpertMTB/RIF combined with T-SPOT-TB detection technology is a simple,fast,and accurate method,and can improve the detection rate and early diagnosis rate of patients with tuberculosis of yin(ie,phlegm smearing yin and peiyin),which is worthy of clinical promotion.