利福平耐药核酸扩增检测联合抗酸杆菌涂片及固体培养法在肺结核临床诊断中的应用

Application of Rifampicin resistant nucleic acid amplification detection combined with acid fast bacilli smear and solid culture in the clinical diagnosis of pulmonary tuberculosis

目的分析利福平耐药核酸扩增检测法(Xpert MTB/RIF)联合抗酸杆菌涂片及固体培养法在肺结核临床诊断中的应用。方法选取2021年10月至2023年2月江西省赣州市赣县区人民医院收治的85例疑似肺结核患者作为观察对象。采用抗酸杆菌涂片法、固体培养法和利福平耐药核酸扩增检测法对患者进行检测。比较单一检查及联合检测结果和四者诊断准确度、特异度、敏感度、阳性预测值和阴性预测值。结果抗酸杆菌涂片法阳性49例,阴性36例,阳性率为58%;固体培养法阳性53例,阴性32例,阳性率为62%;利福平耐药核酸扩增检测法阳性61例,阴性24例,阳性率为72%;联合检查阳性64例,阴性21例,阳性率为75%;联合检测诊断率高于抗酸杆菌涂片法、固体培养法和利福平耐药核酸扩增检测法,差异具有统计学意义(P<0.05)。单一检测敏感度最高的为利福平耐药核酸扩增检测法,联合检测敏感度、特异度和准确度分别为98%、56%、80%。联合检测阳性预测值和阴性预测值分别为97%、86%,均高于单一检测,差异具有统计学意义(P<0.05)。结论利福平耐药核酸扩增检测法联合抗酸杆菌涂片及固体培养法能提高临床肺结核诊断,能提高检测敏感度、特异度和准确度,还能避免“假阳性”问题,值得临床推广应用。

Objective To analyze the application of Rifampicin resistant nucleic acid amplification test(Xpert MTB/RIF)combined with acid fast bacilli smear and solid culture in the clinical diagnosis of pulmonary tuberculosis.Methods Eighty-five suspected pulmonary tuberculosis patients admitted to Jiangxi Provincial Ganzhou City Ganxian District People′s Hospital from October 2021 to February 2023 were selected as observation subjects.Acid fast bacilli smear method,solid culture method and Rifampicin resistant nucleic acid amplification test were used to detect the patients.Compare the diagnostic accuracy,specificity,sensitivity,positive predictive value,and negative predictive value of single test and combined test results with the four.Results Forty-nine cases were positive and 36 cases were negative using the acid fast bacillus smear method,with a diagnostic rate of 58%;53 cases were positive and 32 cases were negative using solid culture method,with a diagnostic rate of 62%;rifampicin resistance nucleic acid amplification test was positive in 61 cases and negative in 24 cases,the diagnostic rate was 72%;64 cases were positive and 21 cases were negative in the combined examination,with a diagnostic rate of 75%;the diagnostic rate of combined detection was higher than that of acid fast bacilli smear method,solid culture method and Rifampicin resistant nucleic acid amplification detection method,and the difference was statistically significant(P<0.05).The single detection method with the highest sensitivity was Rifampicin resistant nucleic acid amplification detection,and the combined detection sensitivity,specificity,and accuracy are 98%,56%,and 80%,respectively.The positive predictive value and negative predictive value of the combined test were 97%and 86%,respectively,which were higher than those of the single test,and the difference was statistically significant(P<0.05).Conclusion Rifampicin resistant nucleic acid amplification test combined with acid fast bacilli smear and solid culture method can improve the clinical diagnosis of pulmonary tuberculosis,improve the sensitivity,specificity and accuracy of detection,and avoid the problem of“false positive”,which is worthy of clinical application.