尿液标本GeneXpert结核分枝杆菌/利福平检测诊断结核病的应用价值

Application value of GeneXpert Mycobacterium tuberculosis/rifampin in urine samples for tuberculosis diagnosis

目的探讨尿液标本GeneXpert结核分枝杆菌(Mycobacterium tuberculosis,MTB)/利福平(rifampin,RIF)检测系统在结核病诊断中的临床应用价值。方法回顾性选择2018年1月1日—2023年6月1日四川大学华西医院收治临床高度疑似结核病患者。分析尿液标本GeneXpert MTB/RIF的诊断效能指标(灵敏度、特异度、阳性预测值、阴性预测值),并评估其在结核病诊断中的临床价值。进一步运用相关性分析探究患者尿液标本GeneXpert MTB/RIF阳性水平等级与实验室检查指标相关性。结果共纳入400例患者。其中,临床结核病组163例,临床非结核病组237例。在临床结核病组中,泌尿系结核病112例,非泌尿系结核病51例。尿液标本GeneXpert MTB/RIF在结核病诊断中的灵敏度、特异度、阳性预测值、阴性预测值分别为55.2%、97.5%、93.8%、76.0%;在泌尿系统结核病中的灵敏度、特异度、阳性预测值、阴性预测值分别为65.2%、92.0%、76.0%、87.2%,其诊断灵敏度进一步提高。相关性分析表明,尿液标本GeneXpert MTB/RIF检测阳性水平与患者血红蛋白、血清总蛋白及血清白蛋白等指标的水平存在相关关系。结论尿液标本GeneXpert MTB/RIF在结核病诊断中具有较高的灵敏度及特异度,尤其是在泌尿系结核中有助于临床对结核病患者早期、快速诊断。尿液标本GeneXpert MTB/RIF检测报告阳性水平可能提示患者疾病严重程度。

Objective To investigate the clinical application value of GeneXpert Mycobacterium tuberculosis(MTB)/rifampin(RIF)in urine samples for tuberculosis diagnosis.Methods The patients with clinically highly suspected tuberculosis admitted to West China Hospital of Sichuan University between January 1,2018 and June 1,2023were selected retrospectively.The diagnostic efficacy of urine GeneXpert MTB/RIF detection,such as sensitivity,specificity,positive predictive value,and negative predictive value,were retrospectively analyzed to evaluate its clinical value in the diagnosis of tuberculosis.Correlation analysis was further conducted to explore the correlation between positive levels of GeneXpert MTB/RIF in urine samples and laboratory test indicators.Results A total of 400 patients were included.Among them,163 cases were in the clinical tuberculosis group and 237 cases were in the clinical non tuberculosis group.In the clinical tuberculosis group,112 cases were urogenital tuberculosis patients and 51 cases were non-urogenital tuberculosis patients.The sensitivity,specificity,positive predictive value,and negative predictive value of urine GeneXpert MTB/RIF in the diagnosis of tuberculosis were 55.2%,97.5%,93.8%and 76.0%,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of urine GeneXpert MTB/RIF in the diagnosis of urogenital tuberculosis were 65.2%,92.0%,76.0%and 87.2%,respectively,and the diagnostic sensitivity was further improved.Correlation analysis showed that the positive degree of urine GeneXpert MTB/RIF was correlated with the levels of hemoglobin,serum total protein,blood serum albumin,and other indicators.Conclusions Urine GeneXpert MTB/RIF detection offers high sensitivity and specificity in the diagnosis of tuberculosis,especially in urogenital tuberculosis,which is helpful for the early and rapid diagnosis of tuberculosis patients.The positive degree reported by the GeneXpert MTB/RIF in urine may indicate disease severity.