摘要
目的 探讨分枝杆菌RNA恒温扩增实时检测技术(SAT-TB)、Xpert-结核分枝杆菌/利福平耐药检测(Xpert-MTB/RIF)对复治肺结核患者快速诊断的应用价值。方法 选取2019年1月至2019年12月在广州市胸科医院疑似复治肺结核患者319例,收集痰或支气管肺泡灌洗液标本,分别采用涂片找抗酸杆菌、分枝杆菌培养法、SAT-TB法及Xpert-MTB/RIF法检测,统计分析各检测方法对复治肺结核诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值。结果 319例患者中最终确诊92例复治肺结核患者,其他非活动性肺结核患者227例;以临床最终诊断为标准评估各指标诊断价值,在复治肺结核患者的诊断灵敏度上,Xpert-MTB/RIF法最高,涂片法最低,差异有统计学意义(χ^(2)=26.302,P<0.05);特异度以SAT-TB法最高,差异有统计学意义(χ^(2)=33.675,P<0.05);诊断准确率方面SAT-TB法与Xpert-MTB/RIF法差异无统计学意义(χ^(2)=0.960,P=0.327),但均显著高于涂片法与分枝杆菌培养法,差异有统计学意义(χ^(2)=22.756,P<0.05);阳性预测值以SAT-TB法最高,差异有统计学意义(χ^(2)=23.435,P<0.05);阴性预测值方面Xpert-MTB/RIF法与分枝杆菌培养法差异无统计学意义(χ^(2)=3.159,P=0.076),但显著高于另外2种检测方法,差异有统计学意义(χ^(2)=19.499,P<0.05)。结论 SAT-TB法对复治肺结核患者具有极高的特异度与准确率,且阳性预测价值高,临床可减少误诊,Xpert-MTB/RIF法具有高灵敏度,临床联合应用可避免漏诊误诊。
Objective To explore the value of SAT-TB and Xpert-MTB/RIF in the rapid diagnosis of retreated pulmonary tuberculosis patients. Methods 319 patients with suspected retreated pulmonary tuberculosis from January 2019 to December 2019 in Guangzhou Chest Hospital were selected. Sputum or bronchoalveolar lavage fluid samples were collected and detected by smear for acid fast bacteria,mycobacterium culture,SAT-TB and Xpert MTB/RIF respectively. The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of each detection method for the diagnosis of retreated pulmonary tuberculosis were analyzed. Results Among the 319 patients,92 patients with retreated pulmonary tuberculosis were finally diagnosed,and 227 patients with other inactive pulmonary tuberculosis. The diagnostic value of each index was evaluated according to the final clinical diagnosis. In terms of the diagnostic sensitivity of retreated pulmonary tuberculosis patients,the Xpert MTB/RIF method was the highest and smear method was the lowest. The difference was statistically significant(χ^(2)=26.302,P<0.05). In terms of specificity,the SATTB method was the highest,the difference was statistically significant (χ^(2)=33.675,P<0.05). In terms of diagnostic accuracy,the SAT-TB method was equivalent to the Xpert MTB/RIF method,the difference was no statistically significant(χ^(2)=0.960,P=0.327),but both were significantly higher than the smear method and the TB culture method,the difference was statistically significant(χ^(2)=22.756,P<0.05). The positive predictive value was the highest with the SAT-TB method,and the difference was statistically significant(χ^(2)=23.435,P<0.05). In terms of negative predictive value,the Xpert MTB/RIF method was equivalent to the TB culture method,the difference was no statistically significant(χ^(2)=3.159,P=0.076),but it was significantly higher than the other two detection methods,and the difference was statistically significant(χ^(2)=19.499,P<0.05).Conclusion The SAT-TB method has high specificity and accuracy for retreated pulmonary tuberculosis patients,and has a high positive predictive value,which can reduce misdiagnosis clinically. The Xpert MTB/RIF method has high sensitivity,and the combined clinical application can avoid missdiagnosis.
作者
李天义
肖海浩
汤春梅
苏雯婕
陈家华
LI Tianyi;XIAO Haihao;TANG Chunmei;SU Wenjie;CHEN Jiahua(The Third District of Internal Medicine,Guangzhou Chest Hospital,Guangzhou,Guangdong,China,510095)
出处
《分子诊断与治疗杂志》
2023年第1期56-59,64,共5页
Journal of Molecular Diagnostics and Therapy
基金
广州市中医药和中西医结合科技项目(20222A010038)
广州市医学重点学科(2021-2023)
广州市高水平临床重点专科(穗卫函[2019]1555号)。
关键词
复治
肺结核
诊断
SAT
分枝杆菌
Retreatment
Pulmonary tuberculosis
Diagnosis
SAT
Mycobacteria
作者简介
通信作者:肖海浩,E⁃mail:xiaohaihao804@163.com。
