Xpert MTB/RIF技术在初治涂阴肺结核中的诊断价值
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摘要
目的探讨Xpert MTB/RIF技术在初治涂阴肺结核患者诊断中的价值。方法选取2014年10月至2016年1月盐城市阜宁县和滨海县临床诊断的341例初治涂阴肺结核患者,对其痰标本进行结核分枝杆菌涂片抗酸染色镜检、罗氏固体培养,并同时进行Xpert MTB/RIF技术检测。结果 341例初治涂阴肺结核中罗氏固体培养阳性39例(11. 44%),阴性302例(88. 56%); Xpert MTB/RIF技术检测阳性52例(15. 25%),阴性289例(84. 75%)。以罗氏固体培养为金标准,Xpert MTB/RIF技术检测结核菌灵敏度为92. 3%,特异性为94. 70%,一致率为94. 43%。Xpert MTB/RIF技术阳性检出中位时间为0天(IQR 0-3),罗氏固体培养阳性检出的中位时间为38天(IQR 19-65)。Xpert MTB/RIF技术共有276例(80. 9%)患者在当天出检测结果,与痰涂片的时效性相仿。结论 Xpert MTB/RIF技术操作简便,时效性好,检测结核分枝杆菌特异性和敏感性较高,对于初治涂阴肺结核的辅助诊断有一定的价值。
Objective To explore the diagnostic value of Xpert MTB/RIF in new smear-negative pulmonary tuberculosis patients. Methods From October 2014 to January 2016,341 patients with clinical diagnosis of new smear-negative pulmonary tuberculosis in Funing and Binhai County of Yancheng city were enrolled. The sputum specimens were examined by acid-stain staining,L-J solid culture and Xpert MTB/RIF simultaneously. Results 39 cases( 11. 44%) were culture-positive and 302cases( 88. 56%) were culture-negative,and 52 cases( 15. 25%) were positive by Xpert MTB/RIF. Taking L-J solid culture as the gold standard,the sensitivity and specificity of Xpert MTB/RIF were 92. 3% and 94. 7%,and the consistent rate was94. 43%. The median positive detected time of Xpert MTB/RIF technique was 0 day( IQR 0-3),while that of L-J solid culture was 38 days( IQR 19-65). A total of 276 cases( 80. 9%) were detected on the same day by Xpert MTB/RIF,which was similar to the timeliness of sputum smear. Conclusion The Xpert MTB/RIF detection method has the merits of simple operation,high time-efficiency,specificity and sensitivity,and has a certain value in the adjuvant diagnosis of patients with initial treatment of bacterial negative pulmonary tuberculosis.
Objective To explore the diagnostic value of Xpert MTB/RIF in new smear-negative pulmonary tuberculosis patients. Methods From October 2014 to January 2016,341 patients with clinical diagnosis of new smear-negative pulmonary tuberculosis in Funing and Binhai County of Yancheng city were enrolled. The sputum specimens were examined by acid-stain staining,L-J solid culture and Xpert MTB/RIF simultaneously. Results 39 cases( 11. 44%) were culture-positive and 302cases( 88. 56%) were culture-negative,and 52 cases( 15. 25%) were positive by Xpert MTB/RIF. Taking L-J solid culture as the gold standard,the sensitivity and specificity of Xpert MTB/RIF were 92. 3% and 94. 7%,and the consistent rate was94. 43%. The median positive detected time of Xpert MTB/RIF technique was 0 day( IQR 0-3),while that of L-J solid culture was 38 days( IQR 19-65). A total of 276 cases( 80. 9%) were detected on the same day by Xpert MTB/RIF,which was similar to the timeliness of sputum smear. Conclusion The Xpert MTB/RIF detection method has the merits of simple operation,high time-efficiency,specificity and sensitivity,and has a certain value in the adjuvant diagnosis of patients with initial treatment of bacterial negative pulmonary tuberculosis.
引文
[1] World Health Organization. Global tuberculosis report 2017[R].Geneva:WHO,2017.
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[4]高春景,朱述阳.支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断价值[J].临床肺科杂志,2016,21(12):2192
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[9]谭英征,陈双华,龙云铸,等.利福平耐药实时荧光定量核酸扩增检测技术对涂阴肺结核诊断价值的评价[J].中国医药导报,2015,12(29):93-96.
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[11]赵雁林,王黎霞,成诗明,等.分枝杆菌分离培养标准化操作程序及质量保证手册[M].北京:人民卫生出版社,2013.
[12]肖东楼,赵明刚,王宇,等.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009.
[13]马艳,成诗明,周林,等.初治涂阴肺结核胸片复读结果与诊断质量多因素分析[J].中国防痨杂志,2011,33(11):707-712.
[14] Helb D,Jones M,Story E,et al. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand,nearpatient technology[J]. Journal of Clinical Microbiology,2010,48(1):229-237.
[15]何贵清,李涛,施伎蝉,等. Xpert MTB/RIF在温州地区诊断肺结核的临床应用评价[C]//浙江省医学会热带病与寄生虫病学分会.全国寄生虫病高峰论坛暨2016年浙江省热带病与寄生虫病学术年会论文汇编,湖州:浙江省科学技术协会,2016:134.
[16] Government of Canada. Canadian Tuberculosis Standards 7th Edition-Chapter 3:Diagnosis of Active Tuberculosis and Drug Resistance[EB/OL].[2018-12-23]. https://www. canada. ca/en/public-health/services/infectious-diseases/canadiantuberculosis-standards-7th-edition/edition-15. html.
[2]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[3]马艳,成诗明,周林.涂阴肺结核诊断和治疗进展[J].中国健康教育,2008,24(6):451-455.
[4]高春景,朱述阳.支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断价值[J].临床肺科杂志,2016,21(12):2192
[5]赵金云,金法祥,许文芳,等.应用Gene Xpert MTB/RIF对耐多药MTB及RIF耐药性的快速检测[J].中华医院感染学杂志,2017,27(19):4340-4343.
[6] Steingart KR,Schiller I,Horne DJ,et al. XpertMTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults[J]. The Cochrane Database of Systematic Reviews,2014(1):1-166.
[7]刘佳庆,张丽霞,秦中华,等. Xpert MTB/RIF和T-SPOT. TB对涂阴肺结核诊断价值的评估[J].临床检验杂志,2016,34(10):755-757.
[8]石海萍,高华.痰Xpert MTB/RIF检查对涂阴肺结核的诊断价值[J].陕西医学杂志,2016,45(1):19-20.
[9]谭英征,陈双华,龙云铸,等.利福平耐药实时荧光定量核酸扩增检测技术对涂阴肺结核诊断价值的评价[J].中国医药导报,2015,12(29):93-96.
[10]刘剑君,中国疾病预防控制中心.中国结核病防治规划痰涂片镜检质量保证手册[M].北京:中国协和医科大学出版社,2004.
[11]赵雁林,王黎霞,成诗明,等.分枝杆菌分离培养标准化操作程序及质量保证手册[M].北京:人民卫生出版社,2013.
[12]肖东楼,赵明刚,王宇,等.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009.
[13]马艳,成诗明,周林,等.初治涂阴肺结核胸片复读结果与诊断质量多因素分析[J].中国防痨杂志,2011,33(11):707-712.
[14] Helb D,Jones M,Story E,et al. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand,nearpatient technology[J]. Journal of Clinical Microbiology,2010,48(1):229-237.
[15]何贵清,李涛,施伎蝉,等. Xpert MTB/RIF在温州地区诊断肺结核的临床应用评价[C]//浙江省医学会热带病与寄生虫病学分会.全国寄生虫病高峰论坛暨2016年浙江省热带病与寄生虫病学术年会论文汇编,湖州:浙江省科学技术协会,2016:134.
[16] Government of Canada. Canadian Tuberculosis Standards 7th Edition-Chapter 3:Diagnosis of Active Tuberculosis and Drug Resistance[EB/OL].[2018-12-23]. https://www. canada. ca/en/public-health/services/infectious-diseases/canadiantuberculosis-standards-7th-edition/edition-15. html.