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核酸扩增检测法快速诊断胸膜结核的价值

Rapid diagnosis of pleural tuberculosis by Xpert MTB/RIF assay

摘要:

目的 利用核酸扩增检测法(Xpert MTB/RIF)检测可疑胸膜结核患者的胸膜活检组织及胸腔积液标本中的MTB并分析利福平的药敏试验结果,评价该方法对胸膜结核快速诊断的价值.方法 收集香港大学深圳医院、南昌大学第一附属医院、江西省胸科医院及南昌大学第二附属医院201 1年1月至2012年11月收治的134例胸膜结核临床疑似患者的胸膜活检组织及胸腔积液标本,分别采用抗酸染色法、罗氏培养基培养法、全自动快速分枝杆菌培养鉴定药敏仪(BACTEC MGIT960系统)培养法及Xpert MTB/RIF检测并进行对比.采用SPSS 17.0统计学软件进行统计分析,诊断性能以敏感度、特异度、阳性预测值及阴性预测值进行评价.结果 以胸膜活检组织标本的传统分离培养结果作为参考方法,Xpert MTB/RIF法以胸膜活检组织作为标本的敏感度和特异度分别为85.5%(47/55)和97.2%(69/71),以胸腔积液作为标本的敏感度和特异度分别为43.6%(24/55)和98.6%(70/71).Xpert MTB/RIF法检测利福平药敏试验结果以BACTEC MGIT960系统的药敏试验结果为参考标准,利福平耐药率及敏感符合率分别为90.9%(9/10)和93.9%(31/33).结合测序分析结果,利福平耐药率及敏感符合率分别为90.9%(10/11)和96.9% (31/32).结论 Xpert MTB/RIF法与传统病原学检测方法比较,具有敏感度及特异度高、检出时间短的优势,适用于对痰标本抗酸染色阴性的可疑胸膜结核患者胸膜结核的临床快速诊断,且胸膜活检组织标本较胸腔积液标本更适合Xpert MTB/RIF法对胸膜结核的准确特异快速诊断.

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abstracts:

Objective Early diagnosis of pleural tuberculosis (TB) is particularly difficult.The aim of this study was to investigate the diagnostic accuracy of the Xpert MTB/RIF (Xpert) assay using pleural biopsy and pleural fluid specimens in patients with suspected pleural TB negative for sputum acid-fast bacilli (AFB) smear.Methods In this study,134 sputum smear-negative suspected pleural TB patients were selected.Paired pleural fluid and pleural biopsy specimens were tested for Mycobacterium tuberculosis by standard smear-microscopy,Lowenstein-Jensen and mycobacterial growth indicator tube (MGIT) culture,and the Xpert assay.Mycobacterial culture from pleural biopsy specimens were used as a reference standard for sensitivity and specificity calculations.Detection of rifampicin resistance was compared to the MGIT method.Results The sensitivity of the Xpert assay using pleural biopsy specimens for the diagnosis of pleural TB was 85.5% (47/55),and the specificity was 97.2% (69/71).The sensitivity and specificity of the Xpert assay in pleural fluid were 43.6% (24/55) and 98.6% (70/71),respectively.The Xpert assay correctly identified 90.0% (10/11) of phenotypic rifampicin-resistant cases and 93.9% (31/33) of phenotypic rifampicin-susceptible cases.Conclusion The Xpert assay on pleural biopsy specimens may provide an accurate diagnosis of pleural TB in patients who had a negative AFB smear.

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