Xpert MTB/RIF检测对淋巴结结核的诊断价值

Diagnostic value of Xpert MTB/RIF in lymph node tuberculosis

目的·分析联合利福平耐药实时荧光定量核酸扩增技术(rifampicin resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system,Xpert MTB/RIF)检测对于提高淋巴结结核诊断率的意义。方法·回顾性分析2016年1月至2018年12月在上海市肺科医院初次诊断为颈淋巴结结核并接受淋巴结穿刺的351例患者的临床资料,包括淋巴结穿刺物的结核分枝杆菌涂片、结核分枝杆菌培养、结核分枝杆菌DNA检测、病理学检测及Xpert MTB/RIF检测结果;分析不同检测方法的阳性率及结核分枝杆菌涂片、结核分支杆菌培养、结核分支杆菌DNA检测、病理学检测分别联合Xpert MTB/RIF检测的阳性率。结果·共纳入145例确诊淋巴结结核的患者。其中,结核分枝杆菌涂片阳性患者39例,结核分枝杆菌DNA阳性患者74例,Xpert MTB/RIF检出患者111例,结核分枝杆菌培养阳性患者51例,病理检测阳性患者87例。Xpert MTB/RIF检出8例利福平耐药患者,其中6例患者结核分枝杆菌培养阴性,2例患者结核分枝杆菌培养阳性并提示利福平耐药。结核分枝杆菌DNA联合Xpert MTB/RIF检测阳性率最高(91.0%),显著高于结核分枝杆菌涂片联合Xpert MTB/RIF检测(80.7%),差异有统计学意义(P=0.017);同时也高于结核分枝杆菌培养联合Xpert MTB/RIF检测(88.3%)及病理检测联合Xpert MTB/RIF检测(90.3%),但差异均无统计学意义(均P>0.05)。结论·联合Xpert MTB/RIF检测可提高淋巴结结核早期诊断率。

Objective·To analyze the significance of the combination of rifampicin-resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system(Xpert MTB/RIF)detection in improving the diagnostic rate of lymph node tuberculosis.Methods·Retrospective analysis was performed on the clinical data of 351 patients who were initially diagnosed with cervical lymph node tuberculosis and received lymph node puncture in Shanghai Pulmonary Hospital from January 2016 to December 2018.The lymph node puncture materials were sent for tuberculosis smear,tuberculosis culture,tuberculosis DNA test,pathology test and Xpert MTB/RIF test.The positive rates of different detection methods and tuberculosis smear,tuberculosis culture,tuberculosis DNA test and pathological test combined with Xpert MTB/RIF test were analyzed.Results·A total of 145 patients with confirmed lymph node tuberculosis were included.Among them,39 patients were tuberculosis smear positive,74 patients were tuberculosis DNA positive,111 patients were Xpert MTB/RIF positive,51 patients were tuberculosis culture positive,and 87 patients were pathologically positive.Xpert MTB/RIF detected 8 patients with rifampicin drug resistance,of which 6 patients were negative in tuberculosis culture,and 2 patients were rifampicin drug resistant in tuberculosis culture.The positive rate of tuberculosis DNA combined with Xpert MTB/RIF was the highest(91.0%),which was significantly higher than that of tuberculosis smear combined with Xpert MTB/RIF(80.7%),and the difference was statistically significant(P=0.017).It was also higher than that of tuberculosis culture combined with Xpert MTB/RIF test(88.3%)and pathology combined with Xpert MTB/RIF test(90.3%),but there was no statistical significance(all P>0.05).Conclusion·The combination of Xpert MTB/RIF could improve the early diagnosis rate of lymph node tuberculosis.