膝关节结核的Xpert MTB/RIF技术诊断及红细胞沉降率与炎症因子变化分析

Diagnosis of knee tuberculosis by xpert MTB/RIF technique and analysis of erythrocyte sedimentation rate and inflammatory factors

目的 探究利福平耐药实时荧光定量核酸扩增检测技术(Xpert技术)在膝关节结核中的技术诊断方法及红细胞沉降率(ESR)与炎症因子变化分析。方法 选取2020年1月至2021年6月该院收治的74例膝关节病变患者作为研究对象。参照临床诊断标准分为膝关节结核组(56例)和非膝关节结核组(18例),另选取同期进行健康体检的体检健康者74例为对照组。研究对象均于术中取病变样本,分别行涂片抗酸杆菌检查、罗氏培养基培养检测、Xpert技术检测,及抽血行ESR检测与炎性因子检测。以英国国家卫生医疗质量标准署(NICE)诊断标准,评价3种检测方法在病变样本中结核分枝杆菌利福平耐药性的灵敏度和特异度;检测ESR及炎性因子变化。结果 Xpert技术检测结果显示诊断正确率、灵敏度、阳性预测率、阴性预测率显著高于涂片法和罗氏法,差异有统计学意义(均P<0.05);膝关节结核组ESR、转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)水平均明显高于非膝关节结核组与对照组,非膝关节结核组ESR、TGF-β、TNF-α水平均明显高于对照组,差异有统计学意义(均P<0.05);受试者工作特征(ROC曲线)显示ESR、TGF-β、TNF-α曲线下面积均>0.7,对预测膝关节结核发病有一定诊断价值。结论 Xpert技术操作简单,耗时短,灵敏度、特异度、生物安全度高,可早期诊断结核分枝杆菌耐药,保证治疗效率。ESR与炎症因子TGF-β、TNF-α可辅助膝关节结核诊断,提高诊断效率,提前耐药治疗时间。

Objective To explore the technical diagnostic method of rifampicin resistance real-time fluorescence quantitative nucleic acid amplification(xpert MTB/RIF)in knee tuberculosis and the changes of erythrocyte sedimentation rate(ESR)and inflammatory factors.Methods Seventy-four patients with knee diseases treated in Chengdu public health clinical medical center from January 2020 to June 2021 were selected as the research objects.According to the clinical diagnostic criteria,they were divided into knee tuberculosis group(56 cases)and non knee tuberculosis group(18 cases),and 74 healthy people were selected as the control group.All the patients took pathological samples during the operation,and underwent smear acid fast bacilli test,Roche medium culture test,xpert technique test,ESR test and inflammatory factor test.The sensitivity and specificity of rifampicin resistance of Mycobacterium tuberculosis in pathological samples were evaluated by"nice"diagnostic standard;The changes of ESR and inflammatory factors were detected.Results The results of xpert technique showed that the diagnostic accuracy,sensitivity,positive prediction rate and negative prediction rate were significantly higher than those of smear method and Roche method,the differences were statistically significant(all P<0.05);ESR and TGF in knee tuberculosis group-β,TNF-αThe levels of ESR and TGF in non knee tuberculosis group were significantly higher than those in non knee tuberculosis group and control group-β,TNF-αThe levels were significantly higher than those in the control group,the difference was statistically significant(P<0.05);ROC curve showed ESR and TGF-β,TNF-αThe area under the curve is>0.7,which has a certain diagnostic value in predicting the incidence of knee tuberculosis.Conclusion xpert technology has the advantages of simple operation,short time-consuming,high sensitivity,specificity and biosafety.It can early diagnose the drug resistance of Mycobacterium tuberculosis and ensure the treatment efficiency.ESR and inflammatory factor TGF-β,TNF-αIt can assist the diagnosis of knee tuberculosis,improve the diagnosis efficiency and advance the time of drug-resistant treatment.