基于利福平耐药结核分枝杆菌半巢式实时荧光定量PCR技术检测胃液结核分枝杆菌在儿童肺结核中的诊断价值

Diagnostic value of gastric fluid Mycobacterium tuberculosis detection based on rifampicin resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system in children with tuberculosis

目的分析基于利福平耐药结核分枝杆菌半巢式实时荧光定量PCR技术(Xpert-MTB/RIF)检测胃液结核分枝杆菌在儿童肺结核中的诊断价值。方法选取2020年1月到2021年12月贵阳市公共卫生救治中心儿童结核科收治50例疑似肺结核患儿作为研究对象,取所有患儿晨起空腹胃液,分别行抗酸染色涂片、Xpert-MTB/RIF及罗氏(L-J)培养检测。以MTB培养作为金标准,分析不同检测方法结果,比较不同检测方法对儿童肺结核的诊断效能,分析Xpert-MTB/RIF及L-J培养阳性患儿MTB利福平耐药性情况及Xpert-MTB/RIF检测法与L-J培养法的药敏试验一致性。结果50例疑似肺结核患儿中,MTB培养结果检出36例肺结核,肺炎14例。抗酸染色涂片法检出阳性1例,阴性49例;L-J培养法检出阳性11例,阴性39例;Xpert MTB/RIF检测法检出阳性18例,阴性32例。Xpert MTB/RIF检测法、L-J培养法对儿童肺结核的诊断灵敏度高于抗酸染色涂片检测法,差异有统计学意义(P<0.05),Xpert MTB/RIF检测与L-J培养法诊断灵敏度比较差异无统计学意义。不同检测方法对儿童肺结核的诊断特异度、阳性预测值、阴性预测值比较差异均无统计学意义。Xpert MTB/RIF检测MTB对利福平的耐药敏感结果与L-J培养法的一致性Kappa值为0.891,具有较高的一致性。结论Xpert MTB/RIF检测较方便与快捷,具有较高的诊断效能,其检测MTB对利福平的药敏试验结果与L-J培养法一致性较高,有利于临床及早诊断儿童肺结核疾病并进行干预指导。

Objective To analyse the diagnostic value of gastric fluid Mycobacterium tuberculosis detection based on rifampicin resistant Myco-bacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system(Xpert-MTB/RIF)in children with tuberculosis.Methods 50 children suspected pulmonary tuberculosis admitted to the department of Children's Tuberculosis in Guiyang Public Health Treatment Centre from January 2020 to December 2021 were selected as the study subjects,and the morning fasting gastric fluids of all children were collected,and antacid stained smear,Xpert-MTB/RIF,and Lowenstein-Jensen(L-J)culture were performed for detection,respectively.MTB culture was used as the gold standard to analyze the results of different detection methods,the diagnostic efficacy of different detection methods in children with pulmonary tuber-culosis was compared,the drug resistance of MTB rifampicin in Xpert-MTB/RIF and L-J culture positive children was analyzed,and the consistency of drug sensitivity test between Xpert-MTB/RIF and L-J culture was analyzed.Results Among the 50 suspected children with tuberculosis,36 cases of tuberculosis and 14 cases of pneumonia were detected by MTB culture;1 case was positive and 49 cases were negative by antacid-fast staining smear method,11 cases were positive and 39 cases were negative by L-J culture method;18 cases was positive and 32 cases was negative by Xpert MTB/RIF detection method.The diagnostic sensitivity of Xpert MTB/RIF detection and L-J culture method were higher than those of acid-fast stain-ing smear method,and the differences were statistically significant(P<0.05),while there was no statistically significant difference in diagnostic sen-sitivity between Xpert MTB/RIF test and L-J culture method;there were no significant differences in diagnostic specificity,positive predictive value and negative predictive value among the different detection methods.The Kappa value of Xpert MTB/RIF detection of MTB resistance to rifampicin was 0.891,which had high consistency with L-J culture method.Conclusion Xpert MTB/RIF is more convenient and quicker,and has high diag-nostic efficacy,the drug sensitivity test results of Xpert MTB to rifampicin are consistent with those of L-J culture method,which is conducive to the early diagnosis of tuberculosis disease in children and the guidance of interventions.