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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (8): 840-845.doi: 10.3969/j.issn.1000-6621.2018.08.012

所属专题: GeneXpert MTB/RIF检测技术相关研究

• 论著 • 上一篇    下一篇

GeneXpert MTB/RIF检测内科胸腔镜活检组织研磨悬液诊断结核性胸膜炎的价值

李成俊(),孙炳奇,孙娇,张威,王洋,吉利,马方   

  1. 110044 沈阳市胸科医院胸膜炎病房(李成俊、张威、王洋、吉利、马方),结核病实验室(孙炳奇、孙娇);
  • 收稿日期:2018-03-21 出版日期:2018-08-10 发布日期:2018-09-09
  • 通信作者: 李成俊 E-mail:13840036215@163.com

The diagnostic value of GeneXpert MTB/RIF of the lapping suspension of the thoracoscopic biopsy tissue in tuberculous pleural effusions

Cheng-jun LI(),Bing-qi SUN,Jiao SUN,Wei ZHANG,Yang WANG,Li JI,Fang. MA   

  1. Department of Pleurisy, Shenyang Chest Hospital, Shenyang 110044, China
  • Received:2018-03-21 Online:2018-08-10 Published:2018-09-09
  • Contact: Cheng-jun LI E-mail:13840036215@163.com

摘要:

目的 评价内科胸腔镜胸膜活检组织标本研磨悬液行结核分枝杆菌GeneXpert MTB/RIF(简称“Xpert”)检测对结核性胸膜炎的诊断价值。方法 选择2017年1月1日至12月31日在沈阳市胸科医院胸膜炎病房住院,行内科胸腔镜检查的不明原因胸腔积液患者51例,均未经过抗结核药物治疗。所有患者胸膜活检组织标本一部分行常规病理检查,另一部分研磨处理后制成悬液,行BACTEC MGIT 960分枝杆菌液体培养(简称“MGIT 960培养”)及Xpert 检测。以MGIT 960培养阳性并菌种鉴定为结核分枝杆菌和胸膜组织活检病理肉芽肿性病变并抗酸染色阳性作为确诊标准,评价活检组织研磨悬液行Xpert检测在结核性胸膜炎诊断中的价值。结果 51例患者中有34例确诊为结核性胸膜炎,其中通过MGIT 960培养阳性并菌种鉴定为结核分枝杆菌而确诊者20例(39.2%,20/51),通过胸膜组织活检病理阳性而确诊者17例(33.3%,17/51),其中3例患者被2种检测方法同时确诊;17例(33.3%)诊断为非结核性胸腔积液。以最终诊断结果为金标准,Xpert法、MGIT 960培养法、病理检查诊断的敏感度和特异度分别为64.7%(22/34)和100.0%(17/17)、58.8%(20/34)和100.0%(17/17)、50.0%(17/34)和100.0%(17/17);Xpert 法检测的敏感度高于MGIT 960培养法和病理诊断,但差异无统计学意义(χ 2=1.53,P=0.466)。结论 内科胸腔镜直视下取胸膜组织活检标本,通过研磨后使其液化,再行结核分枝杆菌Xpert检测,敏感度及特异度均较高,对结核性胸膜炎的确诊具有一定的临床意义。

关键词: 胸腔镜检查, 结核, 胸膜, 活组织检查, 核酸扩增技术, 诊断技术和方法, 对比研究

Abstract:

Objective To assess the diagnostic value of GeneXpert MTB/RIF assay using the lapping suspension of thoracoscopic biopsy tissue in detecting tuberculous pleurisy.Methods From January 1, 2017 to December 31, 2017 in the pleurisy ward of Shenyang Chest Hospital, 51 cases who showed unexplained pleural effusion under medical thoracoscopy and were not treated by any anti-tuberculous therapy were selected as the subjects of this study. A routine pathological examination of the pleural biopsy specimen was conducted for each patient. Also, BACTEC MGIT 960 liquid culture system and GeneXpert MTB/RIF detections were conducted using the suspension of the other part of specimen after grinding. The diagnosis accuracy of GeneXpert MTB/RIF assay using biopsy tissue suspension in detecting tuberculous pleurisy was evaluated, taking BACTEC MGIT 960 positive results (stain identification as Mycobacterium tuberculosis) and pleural tissue biopsy results (granulomatous inflammation and anti-acid staining positive) as diagnostic criteria.Results Of the 51 patients, 34 were diagnosed with tuberculous pleurisy. MGIT 960 positive culture and strain identification confirmed 20 cases (39.2%, 20/51), and 17 cases (33.3%, 17/51) were pleural biopsy pathological positive. Among them, 3 cases were confirmed by the two detection me-thods. Seventeen (33.3%, 17/51) patients were diagnosed with non-tuberculous pleural effusion. Taking the finial diagnosis as the gold standard, the sensitivity and specificity of GeneXpert MTB/RIF, MGIT 960 culture system and pathological diagnosis were 64.7% (22/34) and 100.0% (17/17), 58.8% (20/34) and 100.0% (17/17), and 50.0% (17/34) and 100.0% (17/17), respectively. The sensitivity of GeneXpert MTB/RIF was superior to the MGIT 960 culture system and pathological diagnosis; however, the difference was not statistically significant (χ 2=1.53, P=0.466).Conclusion The sensitivity and specificity of GeneXpert MTB/RIF assay using the lapping suspension of thoracoscopic biopsy tissue taken under thoracoscopy is high. It is of great significance for the diagnosis of tuberculous pleurisy.

Key words: Thoracoscopy, Tuberculosis, pleural, Biopsy, Nucleic acid amplification techniques, Diagnostic techniques and procedures, Comparative study