摘要
目的评估支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)Xpert结核分枝杆菌/利福平试验(Xpert Mycobacterium tuberculosis/rifampicin test,Xpert MTB/RIF)检测对疑似肺结核(pulmonary tuberculosis,PTB)住院患者解除空气传播感染隔离(airborne infection isolation,AII)的预测效能。方法前瞻性纳入2022年11月至2024年1月在陕西省结核病防治院(陕西省第五人民医院)因疑似PTB行纤维支气管镜检查的184例AII住院患者。在AII停止时(以收到出院通知单为准),根据最后1次BALF样本结核分枝杆菌(Mycobacterium tuberculosis,MTB)培养结果阳性或阴性,将患者分为PTB组(n=35)和非PTB组(n=149)。收集所有患者抗酸杆菌(acid-fastbacilli,AFB)痰涂片镜检、BALF样本MTB培养及Xpert MTB/RIF结果。预测AII停止的准确度=诊断为非PTB的患者人数/BALF样本Xpert MTB/RIF检测阴性患者人数×100(%)。结果以MTB培养为金标准,连续3次痰液样本AFB涂片与BALF样本Xpert MTB/RIF检测的特异性与阳性预测值均为100%,而BALF样本Xpert MTB/RIF检测的灵敏性(77.14%vs.71.43%)及阴性预测值(94.90%vs.93.71)分别略高于连续3次痰液样本AFB涂片。与连续3次痰涂片检测相比,BALF Xpert MTB/RIF显著缩短检测时间(24 h vs.59 h,P=0.000)。所有患者中,共有8例(4.35%)患者发生血氧不足事件,12例(6.52%)患者支气管镜检查后发热,但无患者发生术后肺炎。结论BALF Xpert MTB/RIF检测阴性可作为疑似PTB患者安全解除AII的可靠依据,显著缩短隔离时间。
Objective To evaluate the predictive efficacy of the Xpert Mycobacterium tuberculosis/rifampicin test(Xpert MTB/RIF)for bronchoalveolar lavage fluid(BALF)in discontinuation airborne infection isolation(AII)for hospitalized patients with suspected pulmonary tuberculosis(PTB).Methods A total of 184 AII patients admitted to Tuberculosis Provincial Tuberculosis Prevention and Control Hospital(the Fifth People’s Hospital of Shaanxi Province)for suspected PTB from November 2022 to January 2024 were prospectively included.At the time of AII cessation(based on receipt of discharge notification),patients were divided into PTB group(n=35)and non PTB group(n=149)according to the positive or negative Mycobacterium tuberculosis(MTB)culture results of the last BALF sample.The results of sputum smear microscopy of acid fast bacteria(AFB),MTB culture of BALF samples,and real-time fluorescence quantitative nucleic acid amplification(Xpert MTB/RIF)detection for rifampicin resistance were collected.Accuracy in predicting AII cessation=non-PTB patients/patients with BALFXpert MTB/RIF negative test×100(%).Results With MTB culture as the gold standard,the specificity and positive predictive value of 3 consecutive AFB smear of sputum samples and Xpert MTB/RIF of BALF samples were 100%.The sensitivity of Xpert MTB/RIF detection in BALF samples(77.14%vs.71.43%)and negative predictive value(94.90%vs.93.71)were slightly higher than 3 consecutive AFB smears of sputum samples,respectively.Compared with three consecutive sputum smear tests,BALF Xpert MTB/RIF significantly shortened the test time(24 h vs.59 h,P=0.000).Among all the patients,a total of 8(4.35%)patients had hypoxemia events,12(6.52%)patients had fever after bronchoscopy,but no patients had postoperative pneumonia.Conclusion A negative BALF Xpert MTB/RIF test can be used as a reliable basis for the safe release of AII in suspected PTB patients,significantly shortening the isolation time.
作者
卢琼
王婉如
董珍
LU Qiong;WANG Wanru;DONG Zhen(Department of Five Medicine,Shaanxi Provincial Tuberculosis Prevention and Control Hospital(The Fifth People’s Hospital of Shaanxi Province),Xi’an 710100,China)
出处
《传染病信息》
2025年第4期358-362,共5页
Infectious Disease Information
基金
陕西省卫生健康科研基金项目(2018D046)。
