支气管肺泡灌洗液结核分子生物学检测与外周血T细胞斑点试验对痰涂片阴性肺结核患者的诊断价值

Diagnostic value of tuberculosis molecular biological detection of bronchoalveolar lavage fluid and peripheral blood T cell spot test in the sputum smear negative pulmonary tuberculosis patients

目的探讨支气管肺泡灌洗液结核分子生物学检测与外周血T细胞斑点实验对痰涂片阴性肺结核患者的诊断价值。方法选取2020年1月至2021年4月安徽省胸科医院收治的影像学检查怀疑肺结核且痰涂片抗酸杆菌染色阴性的患者198例为研究对象,所有患者均行气管镜检查,取局部支气管肺泡灌洗液标本分别进行结核病(TB)-DNA、TB-RNA、Xpert MTB/RIF检测及外周血T细胞斑点试验,以肺结核诊断标准WS 288—2017为金标准。比较以上4项检查与金标准的一致性,比较支气管肺泡灌洗液Xpert MTB/RIF及外周血T细胞斑点试验联合检查与金标准的一致性,分析各项检查的诊断效能。结果198例患者中确诊肺结核者153例。4项单项检查及支气管肺泡灌洗液Xpert MTB/RIF检测及外周血T细胞斑点试验联合检查与金标准具有一定的一致性(Kappa=0.512、0.449、0.327、0.373、0.793,P<0.05)。支气管肺泡灌洗液Xpert MTB/RIF检测及外周血T细胞斑点试验联合检查的灵敏度为90.20%,特异度为97.78%。结论支气管肺泡灌洗液Xpert MTB/RIF检测及外周血T细胞斑点试验联合检查对痰涂片阴性肺结核患者的诊断与金标准具有一致性,且灵敏度和特异度较好,可用于临床辅助检查。

Objective To explore the diagnostic value of tuberculosis molecular biological detection of bronchoalveolar lavage fluid and peripheral blood T cell spot test in the sputum smear negative pulmonary tuberculosis patients.Methods A total of 198 patients with suspected pulmonary tuberculosis and negative acid-fast bacilli stain on sputum smears admitted to the Anhui Chest Hospital from January 2020 to April 2021 were selected as the study objects.All patients underwent tracheoscopy,local bronchoalveolar lavage fluid samples were taken for tuberculosis(TB)-DNA,TB-RNA,Xpert MTB/RIF detection and peripheral blood T cell spot test,respectively,diagnosis of criteria pulmonary tuberculosis WS 288—2017 was as the gold standard.The consistency of the above four tests with the gold standard was compared,and the consistency of the combination of Xpert MTB/RIF detection in bronchoalveolar lavage fluid and peripheral blood T cell spot test with the gold standard was compared.The diagnostic efficacy of each test was analyzed.Results Among 198 patients,153 were diagnosed as pulmonary tuberculosis.The four single tests and the combination of Xpert MTB/RIF detectionin bronchoalveolar lavage fluid and peripheral blood T cell spot test all had certain consistency with the gold standard(Kappa=0.512,0.449,0.327,0.373,0.793,P<0.05).The sensitivity and specificity of the combination of Xpert MTB/RIF detection in bronchoalveolar lavage fluid and peripheral blood T cell spot test were 90.20%and 97.78%,respectively.Conclusion Bronchoalveolar lavage fluid Xpert MTB/RIF detection combined with peripheral blood T cell spot test in the diagnosis of sputum smear negative pulmonary tuberculosis patients is consistent with the gold standard,and the sensitivity and specificity are good,which can be used for clinical auxiliary examination.