支气管肺泡灌洗液分子生物学联合检测对涂阴肺结核患者的诊断价值

doi:10.19982/j.issn.1000-6621.20250371

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (3): 329-334.doi: 10.19982/j.issn.1000-6621.20250371

支气管肺泡灌洗液分子生物学联合检测对涂阴肺结核患者的诊断价值

侯田勇¹, 任丽萍², 李静颖³, 王建伟⁴, 樊姝慧⁵, 吴渊明⁶, 王全红⁶(), 丁卫民⁷()

¹太原市第四人民医院感染科,太原 030053
²太原市第四人民医院中心实验室,太原 030053
³太原市第四人民医院检验科,太原 030053
⁴太原市第四人民医院综检科,太原 030053
⁵太原市第四人民医院医务科,太原 030053
⁶太原市第四人民医院浆膜腔结核科,太原 030053
⁷首都医科大学附属北京胸科医院内镜中心,北京 101149

收稿日期:2025-09-13 出版日期:2026-03-10 发布日期:2026-03-06
通信作者: 王全红,丁卫民 E-mail:tyssyywk2021@163.com;dwm6606@163.com

Clinical application value of combined molecular biology testing with bronchoalveolar lavage fluid (BALF) for diagnosing smear-negative pulmonary tuberculosis

Hou Tianyong¹, Ren Liping², Li Jingying³, Wang Jianwei⁴, Fan Shuhui⁵, Wu Yuanming⁶, Wang Quanhong⁶(), Ding Weimin⁷()

¹Department of Infectious Diseases, Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
²Central Laboratory, Taiyuan Fourth People’s Hospital,Taiyuan 030053, China
³Department of Laboratory Medicine, Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
⁴Department of Comprehensive Laboratory Medicine, Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
⁵Medical Affairs Department, Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
⁶Department of Serous Tuberculosis, Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
⁷Endoscopy Center, Beijing Chest Hospital Affiliated to Capital Medical University, Beijing 101149, China

Received:2025-09-13 Online:2026-03-10 Published:2026-03-06
Contact: Wang Quanhong,Ding Weimin E-mail:tyssyywk2021@163.com;dwm6606@163.com

摘要/Abstract

摘要：

目的: 探讨支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)分子生物学联合检测(GeneXpert MTB/RIF、PCR-TB-DNA、TB/NTM-PCR、荧光定量PCR、DNA微阵列法)在菌阴肺结核患者诊断中的临床应用价值。方法: 收集2024年1月至2025年4月太原市第四人民医院收治的疑似肺结核且涂片阴性的150例患者为研究对象,采集BALF标本,分别进行GeneXpert MTB/RIF、PCR-TB-DNA、TB/NTM-PCR、荧光定量PCR、DNA微阵列法检测,以临床诊断为参照标准,评估BALF采用5种单一分子生物学及联合检测在涂阴肺结核患者中的诊断价值。结果: 150例患者中,临床诊断为肺结核108例,非结核分枝杆菌肺病7例,非结核病35例,以临床诊断为参照标准,GeneXpert MTB/RIF、PCR-TB-DNA、TB/NTM-PCR、荧光定量PCR、DNA微阵列法的敏感度分别为66.7%(72/108)、62.9%(68/108)、54.6%(59/108)、59.3%(64/108)、62.9%(68/108);特异度分别为100.0%(42/42)、97.6%(41/42)、97.6%(41/42)、97.6%(41/42)、100.0%(42/42);受试者工作特征(ROC)曲线下面积(AUC)分别为0.67、0.60、0.52、0.56、0.62。将5种分子生物学检测方法进行联合应用,GeneXpert MTB/RIF+荧光定量PCR联合检测的诊断效能较高[敏感度为92.5%(100/108),特异度为92.8%(39/42),AUC 为0.85]。结论: 采用BALF样本进行分子生物学联合检测,对于疑诊肺结核且痰涂片阴性患者的早期快速诊断提供了有效的实验室方案,且在诊断效能上全面优于任何单一检测方法,值得临床推广应用。

关键词: 支气管肺泡灌洗, 分子诊断技术, 分枝杆菌, 结核, 诊断, 鉴别

Abstract:

Objective: To investigate the clinical application value of combined molecular biology testing (GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology) with bronchoalveolar lavage fluid (BALF) in the diagnosis of smear-negative pulmonary tuberculosis. Methods: A total of 150 patients with suspected pulmonary tuberculosis and negative smear results admitted to the Fourth People’s Hospital of Taiyuan from January 2024 to April 2025 were enrolled as study subjects. BALF specimens were collected and all underwent GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology. Based on final clinical diagnosis results, the diagnostic value of BALF with different molecular biological testing as well as the combined five methods for smear-negative pulmonary tuberculosis patients was evaluated. Results: Among 150 patients, 108 cases were clinically diagnosed as pulmonary tuberculosis, 7 cases as non-tuberculous mycobacterial infection (NTM), and 35 cases as non-tuberculosis. Using the final diagnosis as the criterion, the sensitivities of GeneXpert MTB/RIF, PCR-TB-DNA, TB/NTM-PCR, fluorescent quantitative PCR, and DNA microarray technology were 66.7% (72/108), 62.9% (68/108), 54.6% (59/108), 59.3% (64/108) and 62.9% (68/108), respectively; the specificities were 100.0% (42/42), 97.6% (41/42), 97.6% (41/42), 97.6% (41/42) and 100.0% (42/42), respectively; and the areas under the receiver operating characteristic (ROC) curve (AUC) were 0.67, 0.6, 0.52, 0.56 and 0.62, respectively. The combined application of five molecular biological methods showed that the strategy combining GeneXpert MTB/RIF with fluorescent quantitative PCR demonstrated excellent diagnostic performance (sensitivity 92.5% (100/108), specificity 92.8% (39/42),AUC=0.85). Conclusion: The combined molecular biological testing using BALF specimens provides an effective laboratory protocol for the rapid early diagnosis of suspected pulmonary tuberculosis patients with negative sputum smear results, demonstrating comprehensive superiority in diagnostic efficacy over any single testing method, which is worthy of clinical promotion and application.

Key words: Bronchoalveolar lavage, Molecular diagnostic techniques, Mycobacterium tuberculosis, Diagnosis, differential

中图分类号:

侯田勇, 任丽萍, 李静颖, 王建伟, 樊姝慧, 吴渊明, 王全红, 丁卫民. 支气管肺泡灌洗液分子生物学联合检测对涂阴肺结核患者的诊断价值[J]. 中国防痨杂志, 2026, 48(3): 329-334. doi: 10.19982/j.issn.1000-6621.20250371

Hou Tianyong, Ren Liping, Li Jingying, Wang Jianwei, Fan Shuhui, Wu Yuanming, Wang Quanhong, Ding Weimin. Clinical application value of combined molecular biology testing with bronchoalveolar lavage fluid (BALF) for diagnosing smear-negative pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(3): 329-334. doi: 10.19982/j.issn.1000-6621.20250371

图/表 3

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参考文献 16

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联合方式	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	准确率 (%)	AUC值
平行试验	96.0(104/108)	85.7(36/42)	94.5(104/110)	90.0(36/40)	93.3(140/150)	0.82
系列试验	62.9(68/108)	100.0(42/42)	100.0(68/68)	51.2(42/82)	73.3(110/150)	0.63
GeneXpert MTB/RIF+荧光定量PCR	92.5(100/108)	92.8(39/42)	97.1(100/103)	82.9(39/47)	92.7(139/150)	0.85
GeneXpert MTB/RIF+PCR-TB-DNA	88.9(96/108)	97.6(41/42)	99.0(96/97)	77.3(41/53)	91.3(137/150)	0.87
PCR-TB-DNA+DNA微阵列	88.0(95/108)	97.6(41/42)	98.9(95/96)	77.3(41/53)	90.7(136/150)	0.86

支气管肺泡灌洗液分子生物学联合检测对涂阴肺结核患者的诊断价值

Clinical application value of combined molecular biology testing with bronchoalveolar lavage fluid (BALF) for diagnosing smear-negative pulmonary tuberculosis

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检测方法	临床诊断(例)		敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	准确度 (%)	AUC值
检测方法	肺结核	非结核性肺部疾病	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	准确度 (%)	AUC值
GeneXpert MTB/RIF			66.7	100.0	100.0	53.8	76.0	0.67
阳性	72	0
阴性	36	42
PCR-TB-DNA			62.9	97.6	98.6	50.6	72.7	0.60
阳性	68	1
阴性	40	41
TB/NTM-PCR			54.6	97.6	98.3	45.6	66.7	0.52
阳性	59	1
阴性	49	41
荧光定量PCR			59.3	97.6	98.5	48.2	70.0	0.56
阳性	64	1
阴性	44	41
DNA微阵列法			62.9	100.0	100.0	51.2	73.3	0.62
阳性	68	0
阴性	40	42

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