摘要
目的探讨Xpert MTB/RIF检测支气管肺泡灌洗液对初治涂阴肺结核的早期快速诊断价值。方法对南通市第六人民医院2015年6月—2018年1月连续三次痰涂片阴性的疑似初治肺结核住院患者332例,在抗结核治疗前行支气管镜检查,收集支气管肺泡灌洗液(Bronchoalveolar lavage fluid,BALF),行结核分枝杆菌涂片、BACTEC MGIT960快速培养及Xpert MTB/RIF检测,比较三种方法的阳性率,并分别以培养阳性及临床诊断为标准,计算Xpert MTB/RIF诊断涂阴肺结核的敏感度、特异度、阳性预测值、阴性预测值。结果共有279例初治涂阴肺结核和53例非肺结核患者入组,279例初治涂阴肺结核的BALF检测结核分枝杆菌涂片、BACTEC MGIT960快速培养及Xpert MTB/RIF阳性率分别为2.51%、25.81%及50.90%,Xpert MTB/RIF阳性率明显高于涂片法及培养法,差异有统计学意义。以MGIT960培养阳性为标准,Xpert MTB/RIF诊断初治涂阴肺结核的敏感度为98.61%(71/72),特异度为100%(53/53);阳性预测值为100.00%(71/71),阴性预测值98.15%(53/54)。以临床诊断为标准,Xpert MTB/RIF诊断初治涂阴肺结核的敏感度为50.9%(142/279),特异度为100%(53/53)。阳性预测值为100%(142/142),阴性预测值27.89%(53/190)。以DST结果为金标准,Xpert MTB/RIF检测利福平耐药的敏感度、特异度分别为87.5%,98.44%,Xpert MTB/RIF与DST两种方法检测利福平耐药的一致率达到97.22%。且检测完成时间仅需2 h。结论 BALF中Xpert MTB/RIF检测敏感度、特异度均较高且能判断是否对利福平耐药,对初治涂阴肺结核有较大的早期快速诊断价值。
Objective To investigate the value of Xpert MTB/RIF in detecting bronchoalveolar lavage fluid(BALF)in the early diagnosis of the initial treatment of smear negative pulmonary tuberculosis.Methods From June 2015 to January 2018,332 patients with suspected the initial treatment of pulmonary tuberculosis admitted in Sixth People’s Hospital of Nantong City were enrolled in the clinical study of three consecutive times with negative sputum smear,and bronchoscopy was performed before anti-tuberculosis treatment.Bronchoalveolar lavage fluid(BALF)was collected,for Mycobacterium tuberculosis smear,BACTEC MGIT960 rapid culture and Xpert MTB/RIF detection.The positive rates of the three methods were compared.The sensitivity,specificity,positive predictive value and negative predictive value of Xpert MTB/RIF in the diagnosis of smear negative the initial treatment of tuberculosis were calculated.Results A total of 279 cases of the initial treatment smear negative pulmonary tuberculosis and 53 cases of non-pulmonary tuberculosis were enrolled in the study.The positive rates of Mycobacterium tuberculosis smear,BACTEC MGIT960 rapid culture and Xpert MTB/RIF were 2.51%,25.81%and 50.90%,the positive rate of Xpert MTB/RIF was significantly higher than that in smear and culture.Taking MGIT960 culture positive results as reference standard,the sensitivity,specificity,positive predictive value,negative predictive value of Xpert MTB/RIF for the initial treatment smear-negative PTB testing BALF were 98.61%(71/72),100%(53/53),100%(71/71),98.15%(53/54).Taking clinical diagnostic criteria as reference standard,the sensitivity,specificity,positive predictive value,negative predictive value of Xpert MTB/RIF for the initial treatment smear-negative PTB testing BALF were 50.9%(142/279),100%(53/53),100%(142/142),27.89%(53/190).With DST results as the gold standard,the sensitivity and specificity of rifampicin resistance using Xpert MTB/RIF were 87.5%,98.44%respectively,and the consistent rate of rifampin resistance detected by Xpert MTB/RIF and DST reached 97.22%.And the detection time was only 2 hours.Conclusion The sensitivity and specificity of Xpert MTB/RIF detection in BALF are relatively high,and it can determine whether it is resistant to rifampicin or not.The detection time is short,which is of great early and rapid diagnostic value for the initial treatment of smear negative pulmonary tuberculosis and is worthy of clinical promotion.
作者
秦志华
施军卫
郑宏
潘海云
张颖颖
QIN Zhihua;SHI Junwei;ZHENG Hong;PAN Haiyun;ZHANG Yingying(Sixth People's Hospital of Nantong City,Nantong,Jiangsu 226011,China)
出处
《中国热带医学》
CAS
2019年第4期382-385,共4页
China Tropical Medicine