结核分枝杆菌rpoB基因和突变检测技术在结核性脑膜炎中的诊断价值

Diagnostic value of rpoB gene and mutation detection technology of Mycobacterium tuberculosis in tuberculous meningitis

目的评价结核分枝杆菌rpoB基因和突变(GeneXpertMTB/RIF)检测技术对结核性脑膜炎(tuberculous meningitis,TBM)的诊断价值。方法回顾性分析2019年1月至2020年6月陕西省结核病防治院收治的同时采用抗酸杆菌(AFB)涂片镜检(简称“AFB涂片”)、BECTECMGIT960液体培养(简称“MGIT960培养”)和GeneXpertMTB/RIF(简称“GeneXpert”)检测的142例疑似TBM患者,其中确诊TBM患者82例、非TBM患者60例。以临床确诊TBM患者为参考标准评价AFB涂片、MGIT960培养和GeneXpert检测对TBM的诊断效能。结果AFB涂片、MGIT960培养和GeneXpert检测的敏感度分别为3.7%(3/82),24.4%(20/82)和40.2%(33/82);特异度均为100.0%(60/60);符合率分别为44.4%(63/142),56.3%(80/142)和65.5%(93/142)。结论AFB涂片技术在诊断TBM时的敏感度很低,MGIT960培养检测技术在诊断TBM时的敏感度较高,而GeneXpert检测技术在诊断TBM时的敏感度更高。

Objective To evaluate the diagnostic value of rpoB gene and mutation GeneXpert MTB/RIF detection technology for tuberculous meningitis(TBM).Methods A retrospective analysis Shaanxi Provincial Tuberculosis Prevention and Treatment Hospital from January 2019 to June 2020.142 patients with suspected TBM were simultaneously examined by acid-fast bacilli(AFB)smear microscopy(abbreviated as“AFB smear”),BECTEC MGIT960 liquid culture(abbreviated as“MGIT960 culture”)and GeneXpert MTB/RIF(abbreviated as“GeneXpert”).Among them,82 cases were confirmed TBM patients and 60 cases were non-TBM patients.The diagnostic efficacy of AFB smear,MGIT960 culture and GeneXpert test on TBM was evaluated with clinically confirmed TBM patients as the reference standard.Results The sensitivity of AFB smear,MGIT960 culture and GeneXpert detection was 3.7%(3/82),24.4%(20/82)and 40.2%(33/82),respectively;the specificity was 100.0%(60/60);the coincidence rate was 44.4%(63/142),56.3%(80/142)and 65.5%(93/142),respectively.Conclusion The sensitivity of AFB smear technology in diagnosing TBM is very low,MGIT960 culture detection technology is more sensitive in diagnosing TBM,and GeneXpert detection technology is more sensitive in diagnosing TBM.