GeneXpert MTB/RIF技术诊断新发结核分枝杆菌感染的价值研究

Value of GeneXpert MTB/RIF technology in diagnosis of Mycobacterium tuberculosis infection

目的探讨GeneXpert MTB/RIF技术(简称Xpert检测)诊断新发活动性肺结核(APTB)的价值。方法选择2017年10月-2018年10月医院收治的404例疑似肺结核患者作为研究对象,比较痰涂片、痰培养和Xpert检测诊断APTB的价值。结果 300例患者诊断为新发APTB,104例最后确诊为肿瘤12例、肺炎65例、支气管炎16例和间质性肺病11例;Xpert检测APTB阳性率为63.00%,高于痰涂片(33.67%)和痰培养(51.00%);199例涂阴APTB患者中,痰培养阳性检出率较Xpert检测低,(31.16%vs 40.7%);Xpert检测的灵敏度高于痰培养,差异有统计学意义(63.00%vs 51.00%;χ~2=11.932,P=0.001),而特异度的比较无统计学意义(98.08%vs99.04%;χ~2=0.338,P=0.561);痰培养和Xpert检测结果均阳性者141例,占47.00%。比例法药敏试验结果为耐药的21例(14.89%)中,Xpert检测结果为耐药者18例(85.71%)、敏感者3例(14.29%);比例法药敏试验结果敏感者120例(85.11%),其中Xpert检测结果为敏感者117例(97.50%)、耐药者3例(2.50%)。Kappa检验发现比例法药敏试验和Xpert检测的一致性较好(Kappa值为0.887≥0.75)。结论 Xpert检测能够较快且较准确地诊断APTB,特别对于涂阴APTB。

OBJECTIVE To explore the value of GeneXpert MTB/RIF technology(Xpert detection)in diagnosis of newly emerging active pulmonary tuberculosis(APTB).METHODS A total of 404 patients with suspected pulmonary tuberculosis who were treated in hospitals from Oct 2017 to Oct 2018 were recruited as the study objects.The values of sputum smear,sputum culture and Xpert detection in diagnosis of APTB were compared.RESULTS Totally 300 patients were diagnosed as newly emerging APTB,12 of 104 patients were finally diagnosed as pulmonary tumor,65 were diagnosed as pneumonia,16 were diagnosed as bronchitis,and 11 were diagnosed as interstitial lung disease.The positive rate of Xpert was 63.00%in the diagnosis of APTB,higher than 33.67%of sputum smear and 51.00%of sputum culture.Among 199 patients who were negative for smear,the positive rate of sputum culture was 31.16%,lower than 40.7%of Xpert detection;the sensitivity of Xpert detection was higher than that of sputum culture,and there was significant difference(63.00%vs 51.00%;χ~2=11.932,P=0.001);however,there was no significant difference in the specificity(98.08%vs 99.04%;χ~2=0.338,P=0.561).Totally 141(47.00%)patients were positive for sputum culture,and 141(47.00%)patients were positive for Xpert detection.The result of proportion drug susceptibility testing showed that 21(14.89%)patients were resistant to antibiotics;the result of Xpert detection showed that 18(85.71%)patients were resistant to antibiotics,and 3(14.29%)patients were sensitive to antibiotics.The result of proportional drug susceptibility testing indicated that 120(85.11%)patients were sensitive to antibiotics,and the result of Xpert detection indicated that 117(97.50%)patients were sensitive to antibiotics,and 3(2.5%)patients were resistant to antibiotics.Kappa test showed that the proportional drug susceptibility testing had high consistency with Xpert detection,with the Kappa value 0.887≥0.75.CONCLUSION Xpert detection may facilitate the rapid and accurate diagnosis of APTB,especially the APTB negative for smear.