肺泡灌洗液和痰液涂片抗酸染色半定量与GeneXpert MTB/RIF半定量分析临床应用

Clinical application of alveolar lavage fluid in GeneXpert MTB/RIF detection and Ziehl-Neelsen staining semi-quantitative detection

目的评估不同类型的标本应用于GeneXpert MTB/RIF对结核病诊治的指导意义。方法回顾性调查分析该院2017年6月至2019年6月249例疑似结核病患者痰液、肺泡灌洗液涂片抗酸染色半定量与GeneXpert MTB/RIF检测半定量是否存在相关性。结果GeneXpert MTB/RIF检测Ct值与涂片染色半定量之间有一致性。当涂片半定量结果为(-)、(+)时,肺泡灌洗液在进行GeneXpert MTB/RIF检测时Ct值不同于痰液,差异有统计学意义(P<0.05);当涂片半定量结果为(++)、(+++)、(++++)时,肺泡灌洗液在进行GeneXpert MTB/RIF检测时的Ct值与痰液差异无统计学意义(P>0.05)。结论结核细菌载量较低时,采集肺泡灌洗液应用于GeneXpert MTB/RIF半定量检测,能够提高结核检出率,支气管镜的广泛使用有助于结核病的诊断。GeneXpert MTB/RIF检测的Ct值对于结核杆菌半定量有重要提示作用。

Objective To investigate the clinical value of different samples apply to GeneXpert MTB/RIF on tuberculosis diagnosis.Methods A total of 249 patients with suspected tuberculosis were retrospectively analyzed from June 2017 to June 2019.The relationship was analyzed between detection quantitative staining semi-smear acid fast and GeneXpert MTB/RIF with sputum and bronchoalveolar lavage fluid.Results The Ct value of GeneXpert MTB/RIF detection was consistent with smear staining semi-quantitative detection.The Ct value of sputum was significantly different from that of bronchoalveolar lavage fluid in GeneXpert MTB/RIF only when smear staining semi-quantitative detection were defined as(-)and(+)(P<0.05).The difference between sputum and bronchoalveolar lavage fluid was not statistically siginificant when smear staining semi-quantitative detection were defined as(++),(+++)or(++++)(P>0.05).Conclusion The application of bronchoalveolar lavage fluid in GeneXpert MTB/RIF can improve the detection rate of tuberculosis when Mycobacterium tuberculosis load is low.The Ct value of GeneXpert MTB/RIF is an important indicator for the semi quantitative detection of Mycobacterium tuberculosis.