基质辅助激光解吸电离飞行时间质谱技术检测支气管肺泡灌洗液对涂阴或无痰肺结核的诊断价值

Diagnostic value of MALDI-TOF for smear-negative or sputum-scarce pulmonary tuberculosis by testing bronchoalveolar lavage fluid

目的分析基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)检测支气管肺泡灌洗液(BALF)对涂阴或无痰肺结核(PTB)的诊断价值。方法以2020年1月至2021年12月安徽省胸科医院收治的87例疑似涂阴或无痰PTB患者为研究对象,对其BALF进行MALDI-TOF MS、SAT-TB、Gene-Xpert及BD960法检测,并对其诊断价值进行比较。结果MALDI-TOF MS诊断涂阴或无痰PTB敏感性为68.5%(37/54),优于SAT-TB 13.0%(7/54)、Gene-Xpert 40.7%(22/54)、BD960法27.8%(15/54)(均P<0.01)。MALDITOF MS法AUC值为0.827,优于SAT-TB 0.550、Gene-Xpert 0.704、BD960法0.639(均P<0.01)。MALDITOF MS分别联合上述3种方法的AUC并不优于其单独检测。结论MALDI-TOF MS是较准确的辅助诊断涂阴或无痰PTB的新方法,有较好的应用前景。

Objective To investigate the efficacy of matrix assisted laser desorption/Ionization-time of flight mass spectrometry(MALDI-TOF MS)for the diagnosis of smear-negative or sputum-scarce pulmonary tuberculosis(PTB)by testing bronchoalveolar lavage fluid(BALF).Methods BALF of 87 patients with suspected smear-negative or sputum-scarce tuberculosis were tested by MALDI-TOF MS,SAT-TB,Gene-Xpert and BD960from January 2020 to December 2021 in Anhui Chest Hospital.The results from those methods were compared.Results The sensitivity of MALDI-TOF MS for diagnosing smear-negative or sputum-scarce PTB was 68.5%(37/54),which was better than that of SAT-TB 13.0%(7/54),or Gene-Xpert 40.7%(22/54),or BD96027.8%(15/54)(all P<0.01).The AUC value of MALDI-TOF MS was 0.827,which was better than that of SAT-TB 0.550,or Gene-Xpert 0.704,or BD9600.639(all P<0.01).Combining MALDI-TOF MS with any one of the other three methods did not produce a better AUC value than using it alone.Conclusion MALDI-TOF MS appears to be a more accurate method in assisting the diagnosis of smear-negative or sputum-scarce PTB.