Gene X-pert MTB/RIF技术在脊柱结核诊断中的作用

The Role of X-pert MTB/RIF Assay in the Diagnosis of Spinal Tuberculosis

目的评价Gene X-pert MTB/RIF X-pert检测脓液、死骨和肉芽组织诊断结核病和结核杆菌对利福平耐药的效能。方法收集2019年5月31日-2020年5月31日确诊的107例脊柱结核患者,选择同期确诊的非结核患者按照3:1进行配对。通过穿刺或术中采集取脓液、死骨和肉芽组织,采用X-pert技术、MGIT960液体培养和药物敏感试验、抗酸涂片染色法对脓液进行分析,比较三种方法检测脊柱结核的阳性率和结核分支杆菌耐药性。以病理结果为金标准,评估X-pert检测的敏感性和特异度。同时利用X-pert技术对脊柱结核患者脓液、肉芽组织和死骨分别进行检测,比较三种组织检测的阳性率。结果运用X-pert对结核组和非结核组进行检测,两组比较差异具有统计学意义,χ^(2)=75.80,P<0.01。以病理诊断为金标准,X-pert检测的灵敏度为92.11%,特异度为38.71%。通过X-pert、MGIT960液体培养和药物敏感试验和涂片抗酸杆菌对脊柱结核患者分别进行了检测,三种方法检出阳性率分别为83.18%、44.86%和28.97%。X-pert耐药率为71.03%,三组比较差异具有统计学意义,χ^(2)=66.61,P<0.05。利用X-pert对脓液、死骨、肉芽组织进行检测,结果显示阳性率分别为83.18%、61.68%、70.09%,且在三种组织中差异具有统计学意义,χ^(2)=12.36,P<0.05。结论 X-pert检测可有效的提高对脊柱结核的确诊率和结核分枝杆菌的筛查率,具有良好的应用价值和前景。

Objective To evaluate the efficiency of Gene X-pert Mtb/RIF detection of pus, granulation tissue and sequestrum specimens diagnosis of TB on drug resistant tuberculosis bacterium of rifampicin.Methods 107 confirmed cases of patients with spinal tuberculosis which is diagnosed from May 31,2019 to May 31,2020 were collected to remove the pus of patients with previous tuberculosis infection. A total of 36 non-Tuberculosis patients were diagnosed in the same period at the ratio of 3:1. Pus, sequestrum and granulation tissue were collected by puncture or intraoperatively. The pus was analyzed by X-Pert technology, MGIT960 liquid culture, drug sensitivity test and acid-fast smear staining. Comparison of the positive rate of spinal tuberculosis and drug resistance of mycobacterium tuberculosis was detected by three methods. The sensitivity and specificity of X-Pert were evaluated by using pathological results as the gold standard. At the same time, X-pert technology was used to detect pus, granulation tissue and sequestrum in patients with spinal tuberculosis and the positive rates of the three tissue tests were compared. Results The difference between the TB group and the non-TB group was statistically significant by using X-Pert(χ^(2)= 75.80,P<0.01). With pathological diagnosis as the gold standard, the sensitivity and specificity of X-Pert test were 92.11% and 38.71% respectively. Spinal tuberculosis patients were detected by X-Pert, MGIT960 liquid culture, drug sensitivity test and smear acid-fast bacilli, and the positive rates of the three methods were 83.18%, 44.86% and 28.97%, respectively. The drug resistance rate of X-Pert was 71.03%, and the difference between the three groups was statistically significant(χ^(2)= 66.61, P<0.05). The positive rates of pus, dead bone and granulation tissue were 83.18%, 61.68% and 70.09%, respectively, using X-Pert, and the difference was statistically significant(χ^(2)=12.36, P<0.05). Conclusion X-pert detection can effectively improve the diagnosis rate of spinal tuberculosis, and the screening rate of Mycobacterium tuberculosis has good application value and prospects.