秦存梅

摘  要：目的  探討Xpert MTB/RIF检测法在支气管肺泡灌洗液结核分枝杆菌检测中的应用价值。方法  选取2018年5月～2019年5月山东省枣庄市肿瘤医院收治的150例疑似肺结核患者为研究对象，以支气管肺泡灌洗液作为病原学检测标本，分别以病原学诊断活动性结核病和临床诊断活动性结核病为金标准，以Xpert MTB/RIF为待测标准，分析Xpert MTB/RIF对病原学和临床诊断结核的诊断价值。结果  在150例灌洗液标本中确诊肺结核130例，离心涂片抗酸染色法抗酸杆菌阳性45例，阳性率为34.62%;Xpert MTB/RIF检测法抗酸杆菌阳性57例，阳性率为43.85%;Xpert MTB/RIF检测法抗酸杆菌阳性率明显高于离心涂片抗酸染色法，差异有统计学意义（P<0.05）。130例肺结核患者中，病原学诊断结核57例（43.95%），临床诊断结核67例（51.54%）;肺结核合并支气管结核102例（78.46%），单纯肺结核107例（82.31%）。Xpert MTB/RIF在病原学诊断和临床诊断结核的敏感度分别为77%（95%CI：63%～88%）和52%（95%CI：41%～63%）（P<0.05）;肺结核合并支气管结核的敏感度为81%（95%CI：67%～89%），单纯肺结核的敏感度46%（95%CI：35%～59%）;病原学诊断和临床诊断结核、合并支气管结核和单纯肺结核特异度均为100%（95%CI：98%～100%）。Xpert MTB/RIF检测病原学诊断结核敏感度高于临床诊断结核，肺结核合并支气管结核敏感度高于单纯肺结核（P<0.05）;支气管肺泡灌洗液的MTB核酸检出载量病原学诊断结核高于临床诊断结核（P<0.05）。结论  支气管肺泡灌洗液Xpert MTB/RIF检测在肺结核诊断中具有较高的价值和敏感性，有助于提高肺结核病因的检出率。

关键词：支气管肺泡灌洗液;Xpert MTB/RIF检测;肺结核;诊断价值

中图分类号：R373.9    文献标识码：A    文章编号：1009-8011（2021）-3-0014-04

Abstract： Objective  To explore the application value of Xpert MTB/RIF detection method in the detection of Mycobacterium tuberculosis in bronchoalveolar lavage fluid. Methods 150 cases of suspected pulmonary tuberculosis patients admitted to Zaozhuang Cancer Hospital in Shandong Province from May 2018 to May 2019 were selected as the research objects. Bronchoalveolar lavage fluid was used as the pathogenic test specimens to diagnose active tuberculosis and clinical diagnosis respectively. Active tuberculosis is the gold standard， and Xpert MTB/RIF is used as the test standard to analyze the diagnostic value of Xpert MTB/RIF in the etiological and clinical diagnosis of tuberculosis. Results Among 150 lavage fluid specimens， 130 cases of tuberculosis were diagnosed， 45 cases were positive for acid-fast bacilli by centrifugal smear acid-fast staining， the positive rate was 34.62%; 57 cases were positive for acid-fast bacilli by Xpert MTB/RIF detection， and the positive rate was 43.85 %; The positive rate of Xpert MTB/RIF detection method of acid-fast bacilli was significantly higher than that of centrifugal smear acid-fast staining method， and the difference was statistically significant（P<0.05）. Among the 130 cases of pulmonary tuberculosis， 57 cases（43.95%） were diagnosed pathogenically， 67 cases（51.54%） were diagnosed clinically; 102 cases（78.46%） of pulmonary tuberculosis complicated with bronchial tuberculosis， and 107 cases（82.31%） of simple pulmonary tuberculosis. The sensitivity of Xpert MTB/RIF in the pathogenic diagnosis and clinical diagnosis of tuberculosis was 77%（95%CI： 63%～88%） Sum 52%（95%CI： 41%～63%）（P<0.05）; the sensitivity of pulmonary tuberculosis combined with bronchial tuberculosis was 81%（95%CI：67%～89%），the sensitivity of simple tuberculosis is 46%（95%CI：35%～59%）; the specificity of pathogenic diagnosis and clinical diagnosis of tuberculosis， combined bronchial tuberculosis and simple pulmonary tuberculosis are all 100% （95%CI： 98%～100%）. Xpert MTB/RIF detection is more sensitive to the pathogenic diagnosis of tuberculosis than the clinical diagnosis of tuberculosis， and the sensitivity of pulmonary tuberculosis combined with bronchial tuberculosis is higher than that of simple pulmonary tuberculosis（P<0.05）; the detection load of MTB nucleic acid in bronchoalveolar lavage fluid is higher In the clinical diagnosis of tuberculosis（P<0.05）. Conclusion Xpert MTB/RIF detection of bronchoalveolar lavage fluid has high value and sensitivity in the diagnosis of pulmonary tuberculosis， which helps to improve the detection rate of the cause of pulmonary tuberculosis.

Keywords： bronchoalveolar lavage fluid; Xpert MTB/RIF detection; pulmonary tuberculosis; diagnostic value

结核病由于细菌数量少等原因，往往难以获得阳性结果，临床上常对结核病进行诊断。研究资料显示[1]，结核病病原学诊断准确率不到40%，对于疑似结核患者涂片阳性率更低。在我国近期颁布的结核病诊断行业标准中，分子生物学方法也被作为病原学诊断的依据之一。因此，寻找新的分子生物学方法并评价其在我国结核病诊断中的应用价值，对于提高临床诊断结核病检测的敏感性具有重要意义。Xpert MTB/RIF方法是一种基于全自动实时半巢式核酸扩增为主的技术，主要用于结核病的快速检测和利福平耐药性的同时检测[2]。基于此，本文选取2018年5月～2019年5月我院收治的150例疑似肺结核患者作为研究对象，旨在探讨Xpert MTB/RIF检测法在支气管肺泡灌洗液结核分枝杆菌检测中的诊断价值，现报如下。……