3种方法在涂阴肺结核早期诊断中的价值分析

The value analysis of three methods in the early diagnosis of smear-negative pulmonary tuberculosis

目的分析利福平耐药实时荧光定量技术(Xpert MTB/RIF)、BACTEC 960培养和药敏及夹层杯技术在涂阴肺结核诊断中的价值。方法实验组为确诊的889例涂阴肺结核病人,对照组为50例肺部其它感染病人,留取痰液标本分别用Xpert MTB/RIF、BACTEC 960培养和药敏及夹层杯法进行检测,分析3种方法的敏感性、特异性及前两种技术检测利福平耐药性的效能。结果痰液Xpert MTB/RIF、BACTEC 960培养及夹层杯技术对涂阴肺结核检测的敏感性分别为50. 35%、20. 40%、10. 61%,特异性分别为97. 92%、100. 00%、100. 00%,Xpert MTB/RIF较BACTEC 960培养和夹层杯法敏感性均高,差异有统计学意义(P=0. 00),3种方法之间特异性差异无统计学意义(P=0. 37)。与传统利福平药敏试验比较,Xpert MTB/RIF检测利福平耐药的敏感性为91. 67%,特异性为99. 21%。结论痰液Xpert MTB/RIF检测技术在涂阴肺结核诊断中具有简便、快速、敏感性及特异性均高的特点,对菌阴肺结核早期诊断及判定利福平耐药有重要应用价值,值得各级实验室大力推广。

Objective To analyze the value of rifampicin-resistant real-time fluorescence quantitative technique(Xpert MTB/RIF),BACTEC 960 culture,drug sensitivity and interlayer vessel method in the diagnosis of smear-negative pulmonary tuberculosis.Methods The experimental group included 889 patients diagnosed with smear-negative pulmonary tuberculosis,and the control group included 50 patients with other pulmonary infections.Sputum samples were collected and detected by Xpert MTB/RIF,BACTEC 960 culture,drug sensitivity and interlayer vessel method,respectively.The sensitivity and specificity of the three methods and the efficacy of the first two techniques for detecting rifampin resistance were analyzed.Results The sensitivity of sputum by Xpert MTB/RIF,BACTEC 960 culture and interlayer vessel method to smear-negative pulmonary tuberculosis were 50.35%,20.40%and 10.61%,respectively,and the specificities were 97.92%,100.00%and 100.00%,respectively.The sensitivity of MTB/RIF was higher than that of BACTEC 960 culture and interlayer vessel method,with statistically significant difference(P=0.00).There was no statistically significant difference in specificity among the three methods(P=0.37).Compared with traditional rifampicin susceptibility test,the sensitivity and specificity of Xpert MTB/RIF for rifampin resistance were 91.67%and 99.21%,respectively.Conclusion Xpert MTB/RIF detection technology has the characteristics of simple,rapid,high sensitivity and specificity in the diagnosis of smear-negative pulmonary tuberculosis,which has important application value in the early diagnosis of bacterial negative pulmonary tuberculosis and the determination of rifampicin resistance,and is worth vigorously promoting in laboratories at all levels.