三种检测技术诊断老年肺结核效能的比较研究

doi:10.3969/j.issn.1000-6621.2018.10.010

中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (10): 1079-1082.doi: 10.3969/j.issn.1000-6621.2018.10.010

三种检测技术诊断老年肺结核效能的比较研究

金法祥^1,^†(),许文芳¹,王晓萌³,柳正卫³,王华钧²,陈雪芳¹,孙小军²

^1.312000 浙江省绍兴市立医院检验科
^2.呼吸内科
^3.浙江省疾病预防控制中心结核病防治所

收稿日期:2018-09-11 出版日期:2018-10-10 发布日期:2018-10-18
通信作者: 金法祥 E-mail:sxjfx0575@126.com
基金资助:
浙江省绍兴市医药卫生科技计划(2016ZH003,2017ZH004);浙江省绍兴市耐多药肺结核研究创新团队绍兴市级创新团队基金

Comparative study on the efficacy of three detection techniques in diagnosis of senile pulmonary tuberculosis

Fa-xiang JIN^1,^†(),Wen-fang XU¹,Xiao-meng WANG³,Zheng-wei LIU³,Hua-yun WANG²,Xue-fang CHEN¹,Xiao-jun. SUN²

^1.Department of Clinical Laboratory, Shaoxing Municipal Hospital, Shaoxing 312000, China

Received:2018-09-11 Online:2018-10-10 Published:2018-10-18
Contact: Fa-xiang JIN E-mail:sxjfx0575@126.com

摘要/Abstract

摘要： 目的

探讨结核分枝杆菌及利福平耐药实时荧光定量核酸扩增(GeneXpert MTB/RIF)技术,发光二极管(light emitting diode,LED)荧光染色法和BACTEC MGIT 960系统液体培养(简称“MGIT液体培养”)诊断老年肺结核的价值。

方法

搜集2013—2015年绍兴市立医院肺科和呼吸感染科收住入院的老年肺结核患者250例,均通过实验室病原学检测、影像学和临床症状综合分析而得到临床确诊。其中,男159例,女91例;年龄65~89岁,平均(70.3±6.2)岁。分别采用LED荧光染色法、MGIT液体培养、GeneXpert MTB/RIF技术对上述患者的250份痰标本进行检测。各组计数资料的比较采用χ²检验,以P<0.05为差异有统计学意义。

结果

LED荧光染色法、MGIT液体培养、GeneXpert MTB/RIF检测的阳性检出率分别为36.00%(90/250),48.40%(121/250)和50.40%(126/250)。GeneXpert MTB/RIF检测阳性率(50.40%)高于LED荧光染色法(36.00%),二者差异有统计学意义(χ²=10.56, P<0.01);高于MGIT液体培养(48.40%),但二者差异无统计学意义(χ²=0.20, P>0.05);MGIT液体培养阳性率(48.40%)高于LED荧光染色法(36.00%),二者差异有统计学意义(χ²=7.88, P<0.01)。以MGIT液体培养检测结果为标准, GeneXpert MTB/RIF技术的检测敏感度、特异度、阳性预测值和阴性预测值分别为95.93%(118/123)、93.70%(119/127)、93.65%(118/126)、 95.97%(119/124);两者检测结果具有极好的一致性(Kappa值为0.90)。

结论

本研究3种检测技术中GeneXpert MTB/RIF技术的检测效能较高,并且与MGIT液体培养检测结果具有高度一致性,具有很好的临床应用和推广价值。

关键词: 老年人, 结核, 肺, 核酸扩增技术, 微生物敏感性试验, 实验室技术和方法, 对比研究

Abstract:

Objective To investigate the diagnostic value of Mycobacterium tuberculosis and rifampicin resis-tance real-time fluorescence quantitative nucleic acid amplification (GeneXpert MTB/RIF), light emitting diode (LED) fluorescence staining and BACTEC MGIT 960 system liquid culture (MGIT liquid culture) in elderly patients with pulmonary tuberculosis.Methods A total of 250 elderly patients with pulmonary tuberculosis admitted to the Department of Pulmonary and Respiratory Infections of Shaoxing Municipal Hospital from 2013 to 2015 were collected. Among them, there were 159 males and 91 females, aged 65-89 years, with an average of (70.3±6.2) years. All of 250 sputum specimens were detected by LED fluorescence staining, MGIT liquid culture and GeneXpert MTB/RIF technique. The chi square test was used to compare between each group, and P<0.05 was considered statistically significant.Results The positive rates of LED fluorescence staining, MGIT liquid culture and GeneXpert MTB/RIF were 36.00% (90/250), 48.40% (121/250) and 50.40% (126/250) respectively. The positive rate of GeneXpert MTB/RIF (50.40%) was higher than that of LED fluorescence staining (36.00%) and the difference was statistically significant (χ²=10.56, P<0.01); and higher than that of MGIT liquid culture (48.40%), but the difference was not statistically significant (χ²=0.20, P>0.05); the positive rate of MGIT liquid culture (48.40%) was higher than that of LED fluorescence staining (36.00%). The difference was statistically significant (χ²=7.88, P<0.01). The sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert MTB/RIF were 95.93% (118/123), 93.70% (119/127), 93.65% (118/126) and 95.97% (119/124) respectively, and the results of the two tests have excellent consistency (Kappa value was 0.90).Conclusion Among the three detection technologies in this study, GeneXpert MTB/RIF has a higher detection efficiency, which is highly consistent with the results of MGIT liquid culture, and has a good clinical application and promotion value.

Key words: Elderly, Tuberculosis, pulmonary, Nucleic acid amplification techniques, Microbial sensitivity tests, Laboratory techniques and procedures, Comparative study

金法祥,许文芳,王晓萌,柳正卫,王华钧,陈雪芳,孙小军. 三种检测技术诊断老年肺结核效能的比较研究[J]. 中国防痨杂志, 2018, 40(10): 1079-1082. doi: 10.3969/j.issn.1000-6621.2018.10.010

Fa-xiang JIN,Wen-fang XU,Xiao-meng WANG,Zheng-wei LIU,Hua-yun WANG,Xue-fang CHEN,Xiao-jun. SUN. Comparative study on the efficacy of three detection techniques in diagnosis of senile pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2018, 40(10): 1079-1082. doi: 10.3969/j.issn.1000-6621.2018.10.010

图/表 1

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三种检测技术诊断老年肺结核效能的比较研究

Comparative study on the efficacy of three detection techniques in diagnosis of senile pulmonary tuberculosis

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GeneXpert MTB/RIF	MGIT液体培养(例)		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
GeneXpert MTB/RIF	阳性	阴性	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
阳性	118	8	95.93	93.70	93.65	95.97	0.90
阴性	5	119