Xpert MTB/RIF、AFB与IGRA对结核病诊断价值的比较

An Analysis of Xpert MTB/RIF, AFB and IGRA in 1 400 Patients

目的分析结核分枝杆菌rpoB基因和突变检测(Xpert MTB/RIF)、涂片抗酸染色镜检(ACID-fast bacilli smear microscopy,AFB)与γ干扰素释放实验(interferon-gamma release assay,IGRA)3种实验方法诊断结核病的价值及差异。方法收集北京同仁医院2019年1月至2021年3月同时检测Xpert MTB/RIF、AFB以及IGRA的患者1400例,以中国国家行业标准WS288-2017作为结核病诊断标准,评价3种检测方法及差异。结果1400例患者中确诊结核病132例,其中肺结核116例,肺外结核16例。Xpert MTB/RIF阳性107例,灵敏度72.7%,特异性为100%;AFB阳性55例,灵敏度为33.3%,特异性为99.1%;IGRA阳性316例,灵敏度为89.4%,特异性为45.3%。结论Xpert MTB/RIF特异性最高,灵敏度较高;IGRA灵敏度最高,特异性较低;AFB灵敏度较低,特异性较高,3种方法各有特点,联合使用有助于临床结核病的诊断。

Objective To analyze the characteristics and differences of Mycobacterium tuberculosis rpoB gene and mutation detection(Xpert MTB/RIF),acid-fast bacilli(AFB)smear microscopy and IGRA in the detection of tuberculosis.Methods 1400 cases of Xpert MTB/RIF,AFB and IGRA were collected from January,2019 to March,2021 in Beijing Tongren Hospital.The Chinese National Industry Standard ws288-2017 was used as the diagnostic standard for tuberculosis diagnosis.The three detection methods were applied and their differences were evaluated.Results 132 cases of tuberculosis were diagnosed in 1400 patients,including 116 cases of pulmonary tuberculosis and 16 cases of extrapulmonary tuberculosis.107 cases of Xpert MTB/RIF were positive,with a sensitivity of 72.7%,and a specificity of 100%;55 cases were positive for AFB,with a sensitivity of 33.3%,and a specificity of 99.1%;316 cases were positive for IGRA,with a sensitivity of 89.4%and a specificity of 45.3%.Conclusion Xpert MTB/RIF has the highest specificity and high sensitivity;IGRA has the highest sensitivity and low specificity;The sensitivity of AFB is low and the specificity is high.Each of these three methods has its own characteristics.The combined use of the three methods is helpful to the diagnosis of clinical tuberculosis.