GeneXpert MTB/RIF检测技术在煤工尘肺并发肺结核患者中的诊断价值

doi:10.3969/j.issn.1000-6621.2021.08.013

摘要/Abstract

摘要：

目的探讨GeneXpert MTB/RIF(简称“Xpert”)检测技术在煤工尘肺并发肺结核患者中的临床诊断价值。方法收集2019年1月至2020年12月在北京京煤集团总医院确诊为煤工尘肺并发肺结核的64例患者的晨痰标本,同时进行痰涂片、BACTEC MGIT 960液体培养(简称“MGIT 960培养”)、Xpert检测。以MGIT 960培养为标准,评价Xpert检测煤工尘肺并发肺结核患者痰标本的敏感度和特异度;并对培养阳性菌株进行利福平耐药检测,将检测结果与Xpert检测结果进行对比。结果以MGIT 960培养结果为金标准,涂片法与Xpert检测对患者MTB检测的敏感度分别为27.8%(5/18)和88.9%(16/18),Xpert检测敏感度高于涂片法,差异有统计学意义(χ²=13.829,P=0.000);Xpert检测与MGIT 960培养一致性中等(Kappa=0.537)。Xpert检测与痰涂片法诊断煤工尘肺并发肺结核的受试者工作特征曲线(简称“ROC”曲线)下面积分别为0.836、0.628,Xpert检测诊断价值较好。以MGIT 960 药物敏感性试验(DST)结果为参照标准,Xpert检测利福平耐药的敏感度为4/4,特异度为78.6%(11/14),一致性为83.3%(15/18),两种检测方法相比差异有统计学意义(χ²=4.889,P=0.027),两种方法检测利福平耐药结果一致性中等(Kappa=0.620)。结论 Xpert检测对煤工尘肺并发肺结核早期诊断及判定利福平耐药具有较高的临床应用价值。

关键词: 尘肺, 结核,肺, 核酸扩增技术, 利福平, 评价研究

Abstract:

Objective To investigate the clinical diagnostic value of GeneXpert MTB/RIF (Xpert for short) in detecting patients with coal workers’ pneumoconiosis complicated with pulmonary tuberculosis. Methods Morning sputum specimens of 64 patients diagnosed with coal workers’ pneumoconiosis complicated with pulmonary tuberculosis in Beijing Beijing Coal Cooperation General Hospital from January 2019 to December 2020 were collected continuously. Sputum smear, BACTEC MGIT 960 liquid culture (referred to as “MGIT 960 culture”) and Xpert test were performed at the same time. Using MGIT 960 culture as the standard, sensitivity and specificity of Xpert in detecting MTB from sputum samples were evaluated. Culture positive strains were tested for rifampicin resistance, compared with Xpert test results. Results Using the liquid culture results of MGIT 960 as the golden standard, the sensitivity of smear test and Xpert test in detection MTB were 27.8% (5/18) and 88.9% (16/18), respectively. The sensitivity of Xpert test was higher than that of smear test, difference was statistically significant (χ²=13.829, P=0.000).The consistency between Xpert test and MGIT 960 liquid culture was moderate (Kappa=0.537). The areas under the receiver operating characteristic curve (ROC) of Xpert test and sputum smear test were 0.836 and 0.628, respectively, which suggested that Xpert test was of good diagnostic value. Using drug sensitivity test (DST) results with MGIT 960 as the reference standard, the sensitivity, specificity and consistency of Xpert were (4/4), 78.6% (11/14) and 83.3% (15/18) for detecting rifampicin resistance. The difference between the two detection methods was statistically significant (χ²=4.889, P=0.027). The consistency of the two methods was moderate (Kappa=0.620). Conclusion Xpert has high clinical application value in the early diagnosis of coal workers’ pneumoconiosis complicated with pulmonary tuberculosis and the determination of rifampicin resistance.

Key words: Pneumoconiosis, Tuberculosis,pulmonary, Nucleic acid amplification techniques, Rifampin, Evaluation studies

杨晓丽, 何兵, 王皎磊, 张云云, 张春霞, 李月, 李建军, 史文韬. GeneXpert MTB/RIF检测技术在煤工尘肺并发肺结核患者中的诊断价值[J]. 中国防痨杂志, 2021, 43(8): 821-825. doi: 10.3969/j.issn.1000-6621.2021.08.013

YANG Xiao-li, HE Bing, WANG Jiao-lei, ZHANG Yun-yun, ZHANG Chun-xia, LI Yue, LI Jian-jun, SHI Wen-tao. Diagnostic value of GeneXpert MTB/RIF in detecting patients with coal workers’ pneumoconiosis complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2021, 43(8): 821-825. doi: 10.3969/j.issn.1000-6621.2021.08.013

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Xpert	BACTEC MGIT 960		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
Xpert	耐药(例)	敏感(例)	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
耐药(例)	4	3	100.0	78.6	57.1	100.00	0.620
敏感(例)	0	11
合计	4	14