GeneXpert MTB/RIF通过胸腔积液对结核性胸膜炎的快速检测

Rapid detection of tuberculous pleurisy by GeneXpert MTB/RIF in pleural effusion

目的评估GeneXpert MTB/RIF通过胸腔积液检测结核性胸膜炎的准确性,并与传统方法进行比较。方法选取2018年2月-2019年2月在本院就诊的34例疑似结核性胸膜炎患者,对其进行胸腔穿刺,收集胸腔积液,并对所有胸腔积液分别进行金胺“O”荧光染色镜检、液体培养及药敏试验和Xpert法检测。结果收集的34份胸腔积液标本中,确诊20例,另14例阴性患者中,2例为非结核分枝杆菌感染。阳性检出率方面,Xpert试验高于涂片镜检、低于MGIT液体培养(P<0.05)。Xpert试验的敏感度为45.00%,特异度为100.00%,其阳性预测值和阴性预测值均高于培养方法。Xpert试验检测出利福平耐药菌株,结果与液体药敏一致。结论GeneXpert MTB/RIF可以作为一种结核性胸膜炎诊断的筛选及快速检测工具;同时可作为检测MDR-TB的一种指标。

Objective To evaluate the accuracy of GeneXpert MTB/RIF assay for the detection of tuberculous pleurisy by pleural effusion and compare with conventional techniques.Methods Thirty four cases of suspected tuberculous pleurisy who were chosen from February 2016 to February 2017 in our hospital were treated with thoracic puncture,pleural effusion was collected to perform auramine"O"fluorescent staining,mycobacterial growth indicator tube(M GIT)culture and drug susceptibility test and Xpert assay.R esults Twenty of the Thirty four cases were diagnosed with tuberculous pleurisy.The other fourteen cases were negative,and two of them were non-tuberculous mycobacterium infections.The positive rate of Xpert assay was higher than the smear microscopy(P<0.05),lower than MGIT liquid culture(P<0.05).The sensitivity of Xpert assay was 45.00%,the specificity was 100.00%,and the positive predictive value and negative predictive value were higher than culture.One rifampicin-resistant strain was detected by Xpert assay and the results were consistent with liquid drug susceptibility.Conclusion GeneXpert MTB/RIF can be used as a screening and rapid detection tool for the diagnosis of tuberculous pleurisy,and is also an indicator to detect MDR-TB.