支气管镜肺泡灌洗术联合结核分子生物学技术对菌阴肺结核的诊断价值

The Diagnostic Value of Bronchoscopic Alveolar Lavage Combined with Tuberculosis Molecular Biology Technology for Bacterial Negative Pulmonary Tuberculosis

目的:本研究评估支气管镜肺泡灌洗液样本进行Xpert MTB/RIF及TB-DNA检测对菌阴肺结核的诊断有效性。方法:对2016年9月~2019年12月在厦门大学附属第一医院杏林分院肺科就诊的316例菌阴且疑似患有肺结核的患者进行回顾性分析。所有患者均行支气管镜肺泡灌洗术,肺泡灌洗液样本均进行了Xpert MTB/RIF、TB-DNA检测和传统的涂片抗酸染色检查,以比较这三种检测方法在菌阴肺结核诊断中的应用价值。结果:在316例患者中,最终有224例被确诊为肺结核,92例非肺结核。肺泡灌洗液的Xpert MTB/RIF检测、TB-DNA检测、Xpert-DNA联合检测以及涂片检测在肺结核诊断中的灵敏度分别为78.57%,73.21%,82.59%和55.80%;而它们的特异度分别为100.00%,100.00%,100.00%和82.61%。结论:利用支气管镜肺泡灌洗液进行Xpert MTB/RIF和TB-DNA检测在菌阴肺结核的诊断上具有较高的准确性,两种方法结合使用具有更大的临床意义。

Objective:This study evaluates the diagnostic effectiveness of Xpert MTB/RIF and TB-DNA detection on bronchoalveolar lavage fluid samples for bacterial negative pulmonary tuberculosis.Methods:A retrospective analysis was conducted on 316 patients with bacterial negative and suspected pulmonary tuberculosis who visited the Pulmonary Department of Xinglin Branch of Xiamen University Affiliated First Hospital from September 2016 to December 2019.All patients underwent bronchoscopic alveolar lavage,and bronchoalveolar lavage fluid samples were subjected to Xpert MTB/RIF,TB-DNA testing,and traditional smear acid fast staining to compare the application value of these three testing methods in the diagnosis of bacterial negative pulmonary tuberculosis.Results:Among these 316 patients,224 were ultimately diagnosed with pulmonary tuberculosis and 92 were non pulmonary tuberculosis.The sensitivity of Xpert MTB/RIF detection,TB-DNA detection,Xpert-DNA combined detection,and smear detection in the diagnosis of pulmonary tuberculosis in alveolar lavage fluid were 78.57%,73.21%,82.59%,and 55.80%,respectively;And their specificity is 100.00%,100.00%,100.00%,and 82.61%,respectively.Conclusion:The use of bronchoscopic alveolar lavage fluid for Xpert MTB/RIF and TB-DNA detection has high accuracy in the diagnosis of bacterial negative pulmonary tuberculosis,and the combination of the two methods has greater clinical significance.