结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测对菌阴空洞肺结核的诊断效能分析

The diagnostic efficacy of real-time quantitative nucleic acid amplification of Mycobacterium tuberculosis/rifampicin-resistant test in pulmonary tuberculosis with bacterial negative cavity

目的探讨结核分枝杆菌/利福平耐药实时荧光定量核酸扩增(Xpert)检测对菌阴空洞肺结核的诊断效能。方法选取河北省胸科医院2021年4月至2022年10月期间行手术治疗的124例肺部空洞疾病患者相关病历资料,其中菌阴空洞肺结核86例(观察组),非结核肺部空洞疾病38例(对照组)。收集患者手术标本Xpert检测和外周血结核感染T细胞斑点(T-SPOT)试验结果,分析二者对菌阴空洞肺结核的诊断效能。结果Xpert检测和T-SPOT试验诊断菌阴空洞肺结核的敏感度为68.6%、75.6%,特异度为97.4%、68.4%。Xpert检测的敏感度低于T-SPOT试验(χ^(2)=5.832,P<0.001),特异度高于T-SPOT试验(χ^(2)=21.469,P<0.001)。2种方法在观察组中的阳性检出率均高于对照组[Xpert检测:68.6%(59/86)比2.6%(1/38);T-SPOT试验:75.6%(65/86)比31.6%(12/38)](均P<0.001)。受试者工作特征曲线分析结果显示,Xpert检测诊断菌阴空洞肺结核的曲线下面积为0.830,T-SPOT试验的曲线下面积为0.729,Xpert检测的准确度高于T-SPOT试验(P<0.001)。结论Xpert检测对菌阴空洞肺结核有比较可靠的诊断效能。

Objective To evaluate the diagnostic efficacy of real-time quantitative nucleic acid amplification of Mycobacterium tuberculosis/rifampicin-resistant test(Xpert) in pulmonary tuberculosis with bacterial negative cavity.Methods From April 2021 to October 2022,data of 124 patients with pulmonary cavity disease admitted to Hebei Chest Hospital were collected,including 86 cases of pulmonary tuberculosis with bacterial negative cavity(observation group) and 38 cases of pulmonary cavity disease without tuberculosis(control group).The results of Xpert for surgical specimens and tuberculosis infection T cell spot test(T-SPOT) for peripheral blood were collected,and the diagnostic efficacy of the two on pulmonary tuberculosis with bacterial negative cavity was analyzed.Results The sensitivities of Xpert and T-SPOT in pulmonary tuberculosis with bacterial negative cavity were 68.6% and 75.6%,and the specificities were 97.4% and 68.4%,respectively.The sensitivity of Xpert was lower than that of T-SPOT(χ^(2) =5.832,P<0.001),and the specificity was higher than that of T-SPOT(χ^(2) =21.469,P<0.001).The positive rates of the two methods in the observation group were significantly higher than those in the control group [Xpert:68.6%(59/86) vs 2.6%(1/38);T-SPOT:75.6%(65/86) vs 31.6%(12/38)](both P<0.001).Receiver operating characteristic curve analysis showed that the area under the curve was 0.830 for Xpert and 0.729 for T-SPOT in pulmonary tuberculosis with bacterial negative cavity,and the accuracy of the Xpert was higher than that of the T-SPOT(P<0.001).Conclusions The detection of Xpert can provide reliable diagnostic support in the diagnosis of pulmonary tuberculosis with bacterial negative cavity,and realize the diagnosis and treatment as early as possible,so as to better control the patient′s condition.