胸腔积液GeneXpert MTB/RIF对结核性胸膜炎的诊断价值研究

Study on the accuracy of GeneXpert MTB/RIF in pleural effusion in the diagnosis of tuberculous pleurisy

目的研究胸腔积液中的GeneXpert MTB/RIF在结核性胸膜炎诊断中的价值。方法回顾性分析2017年11月至2020年11月检测胸腔积液GeneXpert MTB/RIF、PCR-荧光探针法检测结核分枝杆菌DNA(TB-DNA)和腺苷脱氨酶(ADA)的胸腔积液患者的病历。根据综合参考标准(CRS)来判断是否患有结核性胸膜炎,对以上3种方法进行评价和比较。结果总共有128例患者同时接受了GeneXpert MTB/RIF、TB-DNA和ADA的测试,其中结核性胸膜炎患者为78例,患者为非结核性胸膜炎的占有50例。结核组病例中胸腔积液内的ADA的中位水平是44(26,59.25)U/L,高于非结核组患者的胸腔积液中ADA的中位水平11.4(6,15.75)U/L(P<0.05);ROC曲线下面积0.916,诊断最佳临界值为24.5U/L,在此临界值,ADA检测的敏感度和特异度分别为79.5%(62/78)、88%(44/50);胸腔积液GeneXpert MTB/RIF检测的敏感度为26.9%(21/78),特异度为100%(50/50);结核组患者胸腔积液GeneXpert MTB/RIF阳性率26.9%(21/78),分别高于胸腔积液结核菌培养阳性率(16.7%)及胸腔积液TB-DNA检测的阳性率(2.6%)(χ2=2.407,P>0.05;χ2=18.41,P<0.05)。胸腔积液ADA+GeneXpert MTB/RIF的敏感度(82.1%),比胸腔积液ADA检测(79.5%)及胸腔积液GeneXpert MTB/RIF检测(26.9%)单独检测的敏感性要高(χ2=66.117,P<0.05;χ2=6.286,P<0.05)。结论胸腔积液中的ADA检测有助于诊断结核性胸膜炎,该项检测有着高的敏感性和特异性;胸腔积液TB-DNA、GeneXpert MTB/RIF检测的敏感性较低,但特异性均较高,相对而言胸腔积液GeneXpert MTB/RIF比TB-DNA诊断性能更好;胸腔积液GeneXpert MTB/RIF与ADA联合检测可以提高诊断效能。

Objective To investigate the value of GeneXpert MTB/RIF in pleural effusion in the diagnosis of tuberculous pleurisy.Methods The medical records of patients with pleural effusion in Hebei Chest Hospital from November 2017 to November 2020 were collected.GeneXpert MTB/RIF was performed or real-time fluorescent quantitative PCR was used to detect Mycobacterium tuberculosis DNA(TB-DNA)and adenosine deaminase(ADA).According to the Comprehensive Reference Standard(CRS),the diagnosis of tuberculous pleurisy was made,and the above three methods were evaluated and compared.Results A total of 128 patients received GeneXpert MTB/RIF or detection for TB-DNA and ADA in the meantime.Among them,78 had tuberculous pleurisy and 50 had non-tuberculous pleurisy.The median level of ADA in the pleural effusion in the tuberculosis group was 44(26,59.25)U/L,which was higher than that[11.4(6,15.75)U/L]in the pleural effusion in non-tuberculosis group(P<0.05).The area under the ROC curve was 0.916,and the optimal diagnostic critical value was 24.5U/L.At this critical value,the sensitivity and specificity of ADA detection were 79.5%(62/78)and 88%(44/50)respectively.The sensitivity of GeneXpert MTB/RIF in detection of pleural effusion was 26.9%(21/78),and the specificity was 100%(50/50).The positive rate of GeneXpert MTB/RIF in pleural effusion of tuberculosis patients was 26.9%(21/78),which was higher than that of tuberculosis culture in pleural effusion(16.7%)and that(2.6%)of TB-DNA detection in pleural effusion(P<0.05).The sensitivity of ADA+GeneXpert MTB/RIF in pleural effusion(82.1%)was significantly higher than that(79.5%)of ADA detection in pleural effusion and GeneXpert MTB/RIF alone(26.9%)in pleural effusion(P<0.05).Conclusion The ADA detection in pleural effusion is helpful for the diagnosis of tuberculous pleurisy,which has high sensitivity and specificity.TB-DNA detection in pleural effusion and GeneXpert MTB/RIF test have lower sensitivity but higher specificity.GeneXpert MTB/RIF in pleural effusion has relatively better diagnostic performance than TB-DNA,and the combined detection of GeneXpert MTB/RIF and ADA in pleural effusion can improve the diagnostic performance.