痰培养结合GeneXpert MTB/RIF检测对痰涂片阴性肺结核患者的诊断价值

Diagnostic Value of Sputum Culture and Genexpert MTB/RIF Detection in Sputum Smear Negative Pulmonary Tuberculosis Patients

目的痰培养结合GeneXpert MTB/RIF(简称Xpert MTB/RIF)检测对痰涂片阴性肺结核患者的诊断价值。方法选取正阳县疾病预防控制中心2020年1—12月收治的235例痰涂片阴性疑似肺结核患者,患者均接受痰培养和Xpert MTB/RIF检测。比较痰培养与痰培养结合Xpert MTB/RIF MTB检出率、RIF耐药率检测结果。结果235例痰涂片阴性肺结核患者分离128株病原菌,145株革兰阴性菌,以肺炎克雷伯菌(20.00%)、大肠埃希菌(18.30%)、铜绿假单胞菌(12.77%)为主;革兰阳性菌70株,占比29.79%,以肺炎链球菌(13.19%)和化脓性链球菌(8.51%)为主;真菌20株,占比8.51%。痰培养MTB检出率为33.61%,Xpert MTB/RIF MTB检出率为36.60%,痰培养结合Xpert MTB/RIF MTB检出率为43.41%。痰培养结合Xpert MTB/RIF MTB检出率高于痰培养(P<0.05)。痰培养MTB阳性者检测出1例耐RIF患者,耐药检出率为1.27%(1/79),Xpert RIF检测出5例耐RIF患者,耐药检出率为5.81%(5/86),药敏试验结合Xpert RIF检测出6例耐RIF患者,耐药检出率为5.88%(6/102),药敏试验结合Xpert RIF耐药检出率高于痰培养(P<0.05)。结论Xpert MTB/RIF对痰涂片阴性肺结核患者的检出率较高,对RIF耐药率的检测较灵敏,该检测手段对于痰涂片阴性肺结核快速确诊具有较高的临床应用价值。

Objective To study the diagnostic value of sputum culture and GeneXpert MTB/RIF(Xpert MTB/RIF)in sputum smear negative pulmonary tuberculosis patients.Methods A total of 235 patients with sputum smear negative suspected pulmonary tuberculosis treated in Zhengyang Center for Disease Control and Prevention from January to December 2020 were selected.Sputum culture and Xpert MTB/RIF were used.The detection rates of MTB and RIF resistance in sputum culture and sputum culture and Xpert MTB/RIF were compared.Results 128 pathogenic bacteria and 145 Gram-negative bacteria were isolated from 235 patients with sputum smear negative pulmonary tuberculosis.The bacteria were mainly Klebsiella pneumoniae(20.00%),Escherichia coli(18.30%)and Pseudomonas aeruginosa(12.77%).There were 70 strains of Gram-positive bacteria,accounting for 29.79%,mainly Streptococcus pneumoniae(13.19%)and Streptococcus pyogenes(8.51%),and 20 fungi,accounting for 8.51%.The detection rate of MTB in sputum culture was 33.61%,the detection rate of xpertmtb/RIF MTB was 36.60%,and the detection rate of sputum culture and Xpert MTB/RIF MTB was 43.41%.The detection rate of sputum culture and Xpert MTB/RIF MTB was higher than that of sputum culture(P<0.05).One RIF resistant patient was detected in MTB positive sputum culture,and the drug resistance detection rate was 1.27%(1/79).Five RIF resistant patients were detected in Xpert RIF,and the drug resistance detection rate was 5.81%(5/86).Six RIF resistant patients were detected in drug sensitivity test and Xpert RIF,and the drug resistance detection rate was 5.88%(6/102).The drug resistance detection rate of drug sensitivity test and Xpert RIF was higher than that of sputum culture(P<0.05).Conclusion Xpert MTB/RIF has high detection rate and sensitive detection of RIF resistance rate in patients with sputum smear negative pulmonary tuberculosis.This detection method has high clinical application value for the rapid diagnosis of sputum smear negative pulmonary tuberculosis.