抗酸染色、TB-IGRA与Xpert MTB/RIF联合检测在结核病中的诊断价值

Diagnostic value of acid-fast staining, TB-IGRA and Xpert MTB/RIF combined detection in tuberculosis

目的探究抗酸染色、结核分枝杆菌γ-干扰素体外释放试验(TB-IGRA)与结核分枝杆菌及利福平耐药实时荧光定量核酸扩增(Xpert MTB/RIF)联合检测在结核病中的诊断价值。方法回顾性分析2020年1月至2021年12月接收的338例结核病确诊患者和60例健康体检人员的抗酸染色、TB-IGRA和Xpert MTB/RIF实验室检测结果。比较抗酸染色、TB-IGRA、Xpert MTB/RIF单项及联合检测对结核病的诊断结果;以结核分枝杆菌培养结果为诊断金标准,比较抗酸染色、TB-IGRA、Xpert MTB/RIF单项及联合检测对结核病的诊断效能。结果Xpert MTB/RIF对结核病的阳性符合率为79.0%(267/338),明显高于抗酸染色的57.1%(193/338)、TB-IGRA的68.3%(231/338)(P<0.05);抗酸染色对结核病的阳性符合率低于TB-IGRA(P<0.05)。三者联合检测诊断结核病的灵敏度、准确度、阴性预测值明显高于抗酸染色、TB-IGRA、Xpert MTB/RIF、抗酸染色+TB-IGRA、抗酸染色+Xpert MTB/RIF(P<0.05);不同方法诊断结核病的特异度和阳性预测值比较,差异无统计学意义(P>0.05)。结论TB-IGRA和Xpert MTB/RIF在结核病检测方面优势明显大于抗酸染色,三者联合检测可显著提高结核病的诊断效能,值得临床推广。

Objective To explore the diagnostic value of acid-fast staining,Mycobacterium tuberculosis interferon-gamma release assays(TB-IGRA)and GeneXpert Mycobacterium tuberculosis/Ri-fampin(Xpert MTB/RIF)combined detection in tuberculosis.Methods The laboratory tests results of acid-fast staining,TB-IGRA and Xpert MTB/RIF were retrospectively analyzed in 338 patients diagnosed with tuberculosis and 60 healthy physical examination subjects admitted from January 2020 to December 2021.The diagnostic results of single and combined tests of acid-fast staining,TB-IGRA and Xpert MTB/RIF for tuberculosis were compared;using the results of Mycobacterium tuberculosis culture as the diagnostic gold standard,the diagnostic efficacy of single and combined tests of acid-fast staining,TB-IGRA and Xpert MTB/RIF in tuberculosis were compared.Results The positive coincidence rate of Xpert MTB/RIF for tuberculosis was 79.0%(267/338),which was significantly higher than 57.1%(193/338)of acid-fast staining and 68.3%(231/338)of TB-IGRA(P<0.05);the positive coincidence rate of acid-fast staining for tuberculosis was lower than that of TB-IGRA(P<0.05).The sensitivity,accuracy and negative predictive value of the three combined tests were significantly higher than those of acid-fast staining,TB-IGRA,Xpert MTB/RIF,acid-fast staining+TB-IGRA,acid-fast staining+Xpert MTB/RIF(P<0.05);there were no significant differences in the specificity and positive predictive value in diagnosis of tuberculosis among different methods(P>0.05).Conclusion TB-IGRA and Xpert MTB/RIF have obvious advantages over acid-fast staining in tuberculosis detection,and the combined detection of the three can significantly improve the diagnostic efficiency of tuberculosis,which is worthy of clinical promotion.