三种肺结核实验室检测的方法学评价和临床应用价值

Methodolngical evaluation and clinical application vabue of three laboratory tests for pulmonary tubereulosis

目的探讨Xpert(MTB/RIF)法、培养法和涂片法3种方法在结核分枝杆菌及利福平耐药性检测中的临床应用价值。方法收集广州市荔湾中心医院2021年10月至2022年9月结核门诊及住院共529例肺结核患者痰液标本,采用Xpert法、培养法和涂片法3种方法进行结核分枝杆菌及利福平耐药性检测,并对检测结果进行统计分析。结果Xpert法、培养法和涂片法3种检测方法的敏感度分别为40.64%(215/529)、35.35%(187/529)和15.31%(81/529),Xpert法检测的敏感度与培养法差异无统计学意义(χ^(2)=1.23,P>0.05),与涂片法差异有统计学意义(χ^(2)=67.21,P<0.05)。在利福平耐药性检测中,Xpert法检出结核分枝杆菌菌株对利福平的耐药率为22.46%(42/187),Xpert法的敏感度和特异度分别为95.12%(39/41)和97.95%(143/146),与培养法比较差异无统计学意义(χ^(2)=0.167,P>0.05)。结论3种检测方法中Xpert MTB/RIF系统检测结核杆菌及利福平耐药性敏感度及特异度最高,并且可以快速检测,临床应用价值最高,值得推广使用。

Objective To evaluate the clinical application value of three methods,Xpert(MTB/RIF),culture,and smear,in the detection of Mycobacterium tuberculosis and rifampicin resistance.Methods A total of 529 sputum samples were collected from pulmonary tuberculosis patients in the tuberculosis outpatient and inpatient departments of Guangzhou Liwan Central Hospital from October 2021 to September 2022.Three methods,Xpert,culture,and smear,were used to detect Mycobacterium tuberculosis and rifampicin resistance,and the results were statistically analyzed.Results The sensitivity of Xpert,culture,and smear was 40.64%(215/529),35.35%(187/529),and 15.31%(81/529),respectively.There was no significant difference in sensitivity between Xpert and culture(χ^(2)=1.23,P>0.05),but there was a significant difference between Xpert and smear(χ^(2)=67.21,P<0.05).In the detection of rif-ampicin resistance,the detection rate of rifampicin resistance in Mycobacterium tuberculosis strains by Xpert was 22.46%(42/187),and the sensitivity and specificity of Xpert were 95.12%(39/41)and 97.95%(143/146),respectively.There was no significant difference compared to culture(χ^(2)=0.167,P>0.05).Conclusion Among the three detec-tion methods;Xpert MTB/RIF system showes the highest sensitivity and specificity in detecting Mycobacterium tuberculo-sis and rifampicin resistance.It also provides rapid results and has the highest clinical application value;making it worthy of promotion and use.