Xpert MTB/RIF技术在不同类型淋巴结结核中的诊断价值

Diagnosis value of Xpert MTB/RIF assay for different types of lymph node tuberculosis

目的探讨Xpert MTB/RIF技术在不同类型淋巴结结核中的诊断价值。方法选取235例不同类型淋巴结结核患者(淋巴结结核组)和81例非结核性淋巴结病变患者(对照组),分别采用Xpert MTB/RIF技术、抗酸染色和γ干扰素释放试验(IGRA)等方法进行检测,比较3种方法阳性检出率。分析Xpert MTB/RIF技术诊断不同类型淋巴结结核的效能。结果Xpert MTB/RIF技术在淋巴结结核患者中的阳性检出率为84.7%,显著高于对照组(0,P<0.001)。Xpert MTB/RIF技术的敏感性(84.7%)高于抗酸染色(7.7%,P<0.001),但低于IGRA(91.5%,P<0.001);特异性与抗酸染色一致,均为100%,高于IGRA(80.2%,P<0.001)。Xpert MTB/RIF技术对腋窝淋巴结结核的阳性检出率最高(90.2%),但与其他类型淋巴结结核比较,差异无统计学意义(P>0.05)。在干酪样型、增殖型和混合型3种不同病理分型的淋巴结结核中,Xpert MTB/RIF技术的阳性检出率分别为91.7%、78.0%和84.8%,差异无统计学意义(P>0.05)。结论Xpert MTB/RIF技术敏感性高、特异性好、生物危害小,可用于不同类型淋巴结结核的快速诊断。

Objective To investigate the diagnostic value of Xpert MTB/RIF assay for different types of lymph node tuberculosis.Methods Xpert MTB/RIF assay was used to determine 235 patients with different types of lymph node tuberculosis and 81 patients with non-tuberculosis lymphadenopathy(control group),and the positive determination rates were compared with those of acid-fasting staining and gamma-interferon release assay(IGRA).The efficiency of Xpert MTB/RIF assay in the diagnosis of different types of lymph node tuberculosis was analyzed.Results Compared with control group(the positive determination rate was 0),the positive determination rate of Xpert MTB/RIF assay in patients with lymph node tuberculosis was higher(the positive determination rate was 84.7%)(P<0.001).The sensitivity of Xpert MTB/RIF assay(84.7%)was higher than that of acid-fasting staining(7.7%,P<0.001),but it was lower than that of IGRA(91.5%,P<0.001).The specificity was consistent with that of acid-fasting staining(100%),and it was higher than that of IGRA(80.2%,P<0.001).The positive determination rate of Xpert MTB/RIF assay in axillary lymph node tuberculosis was the highest(90.2%),and there was no statistical significance for different types of lymph node tuberculosis(P>0.05).The positive determination rates of Xpert MTB/RIF assay were 91.7%,78.0%and 84.8%in the 3 pathologic types of lymph node tuberculosis with caseous type,proliferative type and mixed type,respectively(P>0.05).Conclusions Xpert MTB/RIF assay is a method with high sensitivity,good specificity and low biohazard,which can be used for the rapid diagnosis of different types of lymph node tuberculosis.