摘要
目的探究气管肺泡灌洗液行利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)检测对菌阴肺结核的诊断效能。方法选取衡水市第三人民医院2017年2月至2018年4月期间收治的疑诊肺结核患者80例,均具有疑似肺结核的临床表现,支气管肺泡灌洗前3次痰涂片抗酸染色阴性或无痰。均取得气管肺泡灌洗液,接受Xpert MTB/RIF检测;同时行涂片法、培养法进行菌种鉴定及药物敏感试验(DST)。以肺泡灌洗液罗氏培养诊断标准、临床诊断标准为肺结核阳性标准,统计Xpert MTB/RIF检测对菌阴肺结核的诊断效能。结果80例疑诊肺结核患者中,培养确诊病例36例、临床诊断病例22例,即肺结核病组58例;余22例为非肺结核病组。肺结核病组中,36例确诊病例中Xpert MTB/RIF检测均为阳性,22例临床诊断病例中18例Xpert MTB/RIF检测为阳性。Xpert MTB/RIF检测诊断菌阴肺结核的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为93.10%、90.91%、96.43%、83.33%、92.50%,均高于80%,其诊断效能明显优于培养法、涂片法。以DST结果为金标准,Xpert MTB/RIF检测利福平耐药的敏感度、特异度为62.50%、89.29%,Xpert MTB/RIF检测利福平耐药与DST结果一致率为83.33%,Kappa检验一致性好。结论气管肺泡灌洗液行Xpert MTB/RIF检测诊断菌阴肺结核的临床价值高,并可快速判断是否利福平耐药。
Objective To investigate the diagnostic efficiency of rifampicin-resistant real-time quantitative nucleic acid amplification technology(Xpert MTB/RIF)detection of bronchoalveolar lavage fluid to smear and culture negative tuberculosis.Methods Total of 80 cases with suspected pulmonary tuberculosis who were admitted to our hospital during the period from February 2017 to April 2018 were selected.All of them had clinical manifestations of suspected pulmonary tuberculosis.Three times of sputum smear acid-fast staining showed negative Results or none phlegm before bronchoalveolar lavage.The Xpert MTB/RIF detection of bronchoalveolar lavage fluid was performed.The smear method and the culture method were used for strain identification and drug sensitivity test(DST).With Lowenstein-Jensen culture diagnostic criteria and clinical diagnostic criteria of bronchoalveolar lavage fluid as positive standard for tuberculosis,the diagnostic efficiency of Xpert MTB/RIF detection for culture negative tuberculosis was statistically analyzed.Results Total of 80 patients with suspected pulmonary tuberculosis,36 cases were confirmed by culture and 22 were clinically diagnosed,ie 58 patients in the tuberculosis group.The remaining 22 cases were included in the non-tuberculosis group.In the tuberculosis group,Xpert MTB/RIF detection was positive in 36 confirmed cases and 18 of the 22 clinically diagnosed cases.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Xpert MTB/RIF detection for diagnosis of culture negative tuberculosis were 93.10%,90.91%,96.43%,83.33%and 92.50%,respectively.And all of which were higher than 80%.The diagnostic efficiency was significantly better than that of the culture method and the smear method.With DST results were used as the golden standard,the sensitivity and specificity of Xpert MTB/RIF detection for rifampicin resistance were 62.50%and 89.29%.The agreement rate of rifampicin resistance detected by Xpert MTB/RIF with results of DST was 83.33%.The Kappa test showed good consistency.Conclusion The clinical value of Xpert MTB/RIF detection of bronchoalveolar lavage fluid for culture negative tuberculosis is high,and it can be used to quickly judge rifampicin resistance.
作者
李丹
陈丽茹
刘玉洁
Li Dan;Chen Liru;Liu Yujie(Department of Clinical Laboratory,The Third People’s Hospital of Hengshui City,Hengshui 053000,Hebei,China)
出处
《贵州医药》
CAS
2019年第12期1867-1870,共4页
Guizhou Medical Journal
基金
衡水市重点研发计划项目(201812)
关键词
气管肺泡灌洗液
利福平耐药实时荧光定量核酸扩增技术
肺结核
Bronchoalveolar lavage fluid
Rifampicin-resistant real-time fluorescence quantitative nucleic acid amplification technology
