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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (6): 584-589.doi: 10.3969/j.issn.1000-6621.2021.06.011

• 论著 • 上一篇    下一篇

GeneXpert MTB/RIF Ultra检测胃液标本对儿童肺结核的诊断价值

方敏, 石艳, 段莉, 石小梅, 全舒婷, 王亚翠, 彭小姗, 郏继航, 綦辉, 焦伟伟, 朱渝(), 孙琳()   

  1. 615000 西昌, 四川省凉山彝族自治州第一人民医院儿科(方敏、石艳、段莉、石小梅);首都医科大学附属北京儿童医院呼吸疾病研究室 北京市儿科研究所 儿科学国家重点学科 教育部儿科重大疾病研究重点实验室 儿童呼吸道感染性疾病研究北京市重点实验室(全舒婷、王亚翠、綦辉、焦伟伟、孙琳);四川大学华西第二医院感染科(彭小姗、郏继航、朱渝)
  • 收稿日期:2021-03-09 出版日期:2021-06-10 发布日期:2021-06-02
  • 通信作者: 朱渝,孙琳 E-mail:zhuyu_wj@163.com;chinatka@163.com
  • 基金资助:
    “十三五”国家科技重大专项(2018ZX10103001-003);“十三五”国家科技重大专项(2018ZX10101004-002-005)

Diagnostic value of GeneXpert MTB/RIF Ultra for pulmonary tuberculosis in children using gastric juice

FANG Min, SHI Yan, DUAN Li, SHI Xiao-mei, QUAN Shu-ting, WANG Ya-cui, PENG Xiao-shan, JIA Ji-hang, QI Hui, JIAO Wei-wei, ZHU Yu(), SUN Lin()   

  1. Department of Pediatrics, the First People’s Hospital of Liangshan Yizu Autonomous Prefecture, Sichuan Province, Xichang 615000, China
  • Received:2021-03-09 Online:2021-06-10 Published:2021-06-02
  • Contact: ZHU Yu,SUN Lin E-mail:zhuyu_wj@163.com;chinatka@163.com

摘要:

目的 评价超敏结核分枝杆菌及利福平耐药基因检测(GeneXpert MTB/RIF Ultra,简称“Xpert Ultra”)技术检测胃液标本对儿童肺结核的诊断价值。方法 采用回顾性研究方法选取2019年7月至2020年7月就诊于四川省凉山彝族自治州第一人民医院儿科的患儿作为研究对象,其中符合入组标准的173例,包括经临床综合诊断为活动性肺结核患儿114例(观察组),其他呼吸系统感染性疾病患儿59例(对照组)。收集患者胃液标本和(或)痰液标本行结核分枝杆菌(MTB)培养和Xpert Ultra检测。以临床综合诊断为参照标准,评价Xpert Ultra检测胃液和痰液标本对儿童肺结核的诊断价值。结果 以临床综合诊断为参照标准,Xpert Ultra检测胃液标本对儿童肺结核诊断的敏感度、特异度、一致率和Kappa值分别为53.5%(61/114)、98.3%(58/59)、68.8%(119/173)和0.43;其中,检测0~6岁(学龄前组)患儿胃液标本对肺结核诊断的敏感度[66.7%(26/39)]明显高于6~14岁组(学龄期组)[敏感度为46.7%(35/75)],差异有统计学意义(χ2=4.126,P=0.042)。而胃液标本MTB培养诊断儿童肺结核的敏感度仅为20.2%(23/114)。65例同时行胃液标本和痰液标本Xpert Ultra检测的患儿中,Xpert Ultra检测胃液标本诊断肺结核的敏感度为52.2%(24/46),高于检测痰液标本诊断肺结核的敏感度[43.5%(20/46)],但差异无统计学意义(χ2=0.697,P=0.404)。MTB培养阴性的150例患儿,40例经Xpert Ultra检测阳性,其微量MTB的检出率为37.5%(15/40);而MTB培养阳性的23例患儿微量MTB的检出率为14.3%(3/21)。在Xpert Ultra检测阳性的61例患儿中,5例检出利福平耐药。结论 Xpert Ultra检测胃液标本对儿童肺结核诊断具有较好的价值,有助于儿童结核病的早期诊断。对于无法咳痰或难以取得合格痰液标本的学龄前儿童,胃液标本是很有价值的替代标本类型。

关键词: 儿童, 结核, 胃液, 早期诊断, 分子诊断技术

Abstract:

Objective To evaluate the performance of GeneXpert MTB/RIF Ultra (Xpert Ultra) for pulmonary tuberculosis (PTB) diagnosis in children using gastric juice. Methods In this retrospective study, a total of 173 eligible children were enrolled, who admitted to Pediatric Department of the 1st People’s Hospital of Liangshan Yizu Autonomous Prefecture between July 2019 and July 2020. Using composite reference standard (CRS) as reference, 114 of them were diagnosed with PTB (case group), and 59 were non-TB patients with other respiratory infectious diseases (control group). Gastric juice and sputum samples were collected and subjected to culture and Xpert Ultra. The performance of Xpert Ultra was evaluated in gastric juice and sputum samples using CRS as gold standard. Results Using CRS as reference, the diagnostic sensitivity, specificity, accordance rate and Kappa value of Xpert Ultra for PTB diagnosis in children using gastric juice samples was 53.5% (61/114), 98.3% (58/59), 68.8% (119/173) and 0.43, respectively. The sensitivity of Xpert Ultra using gastric juice samples in pre-school (0-6 years) children was significantly higher than that in school-aged (6-14 years) children (66.7% (26/39) vs. 46.7% (35/75),χ2=4.126, P=0.042). The sensitivity of MTB culture was only 20.2% (23/114). Among 65 children who underwent Xpert Ultra of both gastric juice and sputum samples, the sensitivity of Xpert Ultra in gastric juice samples was higher than that in sputum samples (52.2% (24/46) vs. 43.5% (20/46)). However, the difference was not significant (χ2=0.697, P=0.404). Among 150 culture-negative children, 40 were positive using Xpert Ultra, in which trace result accounted for 37.5% (15/40). The percentage of trace result was only 14.3% (3/21) among culture-positive children. Five children were found to be rifampicin resistant among 61 Xpert Ultra-positive patients. Conclusion The performance of Xpert Ultra for PTB diagnosis in children using gastric juice samples is good, making it useful for early diagnosis of pediatric TB. The gastric juice samples are valuable alternative types for those who can’t expectorate or preschool children who can’t provide qualified sputum samples.

Key words: Child, Tuberculosis, Gastric juice, Early diagnosis, Molecular diagnostic techniques